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Nov 2021 – SL/CT 
 
 
Application for Extension on Assignment 
    
 
• This form is to be used by students who believe they have exceptional circumstances for why their assignment task willl be late. 
• Normal occupational commitments and extracurricular activities are not accepted as grounds for granting extra time because 
you are expected to plan effectively. 
• For more information, see: Can I get an extension for my assignment? 
 
Section A: STUDENT AND COURSE DETAILS - ALL FIELDS AND QUESTIONS TO BE ANSWERED 
Student Number  
First Name  Surname  
 
Unit Details 
Unit Code   Unit Title   
Assignment  
Due Date  
Reason for extension reqeust: 
☐ I have attached supporting documentation and/or evidence which may support your request.  
Student’s 
Signature   Date  
COMPLETED FORM IS TO BE SUBMITTED TO THE UNIT COORDINAOR  
AUTHORISATION 
Outcome 
☐ Extension Granted New Due Date  
☐ Extension Declined Date Student Advised  
Reason request was declined:  
Authoriser’s 
Signature  Date  
Authoriser’s  
Name  
THIS FORM IS TO BE RETAINED BY THE SCHOOL AND A COPY IS TO BE SENT TO THE STUDENT