Sickness or Misadventure Form

This form is to be used by students on the Duncan Campus if an assessment or exam is missed for the following reasons:

Temporary Illness
Non-permanent Disability
Unforeseen Event

It may also be used in instances where the student believes the above situations may have affected their results to the point where their performance in an assessment or exam was below expectations.

This form must be submitted within two days of returning to school, with accompanying medical evidence. Additional documentation can be attached to the form to support the claim. Year 11 and 12 students MUST include supporting documentation in order to have their application assessed.

Completion and submission of this form DOES NOT guarantee approval. The relevant Learning Area Coordinator is responsible for approval of any special consideration granted, based on the information contained in this application.

Basis of Application*
Student Name*
First Last
Year*
Form*
Nature of Illness/Misadventure*
Please provide a description which details the nature of your illness/misadventure, preventing you from missing an assessment/exam.
Supporting Documentation (Year 11/12 ONLY)
Please include a signed Medical Declaration Certificate and/or other supporting documentation to support your claim.
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 2 MB.
Date of Missed Assessment/Exam*
For students who have missed their assessment/exam or wish to have their illness/misadventure taken into account during the marking process.

Day
Month
Year
Subject/Teacher*
Please provide a listing of ALL Subjects and Teachers for which you have missed assessments/exams.
Student Declaration*
Students must declare that they have provided accurate and truthful information in their application and that they have discussed this application with their parent/guardian before submitting.
I declare that the information contained in this application, including any/all supporting documentation, is both truthful and accurate.