MHE - Deferred Examination Application Form

Deferred Examination Application Form

Completed forms with accompanying documentary evidence are to be submitted to Student Services via your local campus Student Adviser at least three (3) days before the scheduled date of the examination. Incomplete submissions will not be considered.

In rare situations where that is not possible, applications will be accepted until three business days after the scheduled examination date.
Only examinations which are worth 15% or more of the final grade for a subject are able to be deferred.

Approval for Deferred Examination may be granted on the following grounds:

Serious personal or emotional trauma (such as a death in the immediate family)
Serious student illness which would prevent attendance at the College
Religious observances which clash with the published Examination Timetable
Sporting or cultural commitments at State, national or international level.

Supporting evidence in the form of a Statutory Declaration (contained herein), together with Medical Certificate or other substantiating documentation, must accompany this application form. Any supporting evidence must provide detailed reasons as to why you are unable to attend the scheduled examination date.

For further information refer to the policies and procedures located on the College’s website including theExamination Policy - HE Martin.

IMPORTANT:

If claiming serious illness as the reason for deferral application, a medical certificate will be required which details your lack of fitness to sit an exam, and which must cover all relevant dates that the exam was available to sit (i.e. online exams are available for a number of days).

The deferred examination (either theory or practical) must be completed on the date/s and time provided to you on approval of your application for deferred examination. These dates are not negotiable.

The following are not considered grounds for examination deferral and applications for deferral and need to be applied for through the MHE - Special Consideration Application Form:

Other study commitments (including clinic or class attendance)
Work commitments
Holiday arrangements
Social and leisure events or personal commitments
Misreading the examination timetable
Forgetfulness.

Kindly contact the Student Adviserat your local College campusif you have any questions about completing this form.

Once completed, please send this Form including required documentary evidence to theStudent Adviser at the College via .

PERSONAL DETAILS

Student Number / Date of Birth
Title / Given Name / Family Name
Phone Number / Additional Phone
Address
Suburb / State / Postcode
Email

EXAMINATION DETAILS

Complete a separate application form for each missed examination

Subject Code / Subject Name
Class - Day / Time
Original Date of Examination / % Weighting of Examination (within subject)
Lecturer Name
The subject is / ☐ On campus / ☐ Online
The examination is / ☐ Mid-semester exam / ☐ Final Exam / ☐ Quiz
Does the exam contain any practical component? / ☐ Yes / ☐ No

REASON FOR DEFERRAL*

(To be completed on the Statutory Declaration overleaf, with supporting evidence attached)

*Please note – this application for deferred examination will not be accepted by the College without the completed/signed Statutory Declaration and any other supporting evidence.

DECLARATION

I (the undersigned), declare that:

☐ I have read and understood the policies related to this form and that the information I have provided within this document is true, correct and complete in every respect.
☐ I have included any documentary evidence required.I acknowledge that the submission of false, incorrect, incomplete or misleading information may result in cancellation of my enrolment and/or delays in processing this request.
☐ I acknowledge that the Policies and Procedures have been made available to me online and I have read, understood and accepted these as conditions of my enrolment including the Assessment Policy
Student Name
Student Signature / Date
If under 18 years of age at time of application, signature of a parent or legal guardian is required
Parent/Guardian Name
Parent/Guardian Signature / Date

OFFICE USE ONLY

Date initially received / Reviewed by (Student Adviser) / ☐ Noted in FileMaker
NOTE: Student Advisers are to review these forms prior to submission to the Student Services Team Leader
☐ Accepted / ☐ Rejected / Reason for rejection
Date sent to Student Services Team Leader / Date reviewed by Student Services Team Leaders
☐ Accepted / ☐ Rejected / ☐ Further consultation required / Reason for rejection
Date sent to National Manager, Student Services / Date reviewed by National Manager, Student Services
☐ Accepted / ☐ Rejected / ☐ Further consultation required / Reason for rejection
Date sent to Director, SS&R / Date reviewed by Director, SS&R
☐ Accepted / ☐ Rejected / Reason for rejection
Finalisation of Outcome
☐ Outcome recorded in SMS / Date response letter sent / Processed by

Study Group Australia Pty Limited trading as Martin College, Martin Higher Education (National CRICOS Provider #01682E)

MHE - Deferred Examination Application Form - F-181 / Effective Date: 14-Jun-17
Version: 2.0 / Page 1 of 4

Commonwealth of Australia

STATUTORY DECLARATION

Statutory Declarations Act 1959

1Insert the name, address and occupation of person making the declaration / I,1……………………………………………………………………………………………………………......
…………………………………………………………………………………………………………………..
make the following declaration under the Statutory Declarations Act1959:
2Set out matter declared to in numbered paragraphs / 2………………………………………………………………………………………………...... ……
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I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959,and I believe that the statements in this declaration are true in every particular.
3Signature of person making the declaration / 3………………………………………………………………………………………………………………….
4Place
5Day
6Monthand year / Declared at 4………………………………. on 5……………………….. of 6………………………………
Before me,
7Signature of person before whom the declaration is made (see over) / 7………………………………………………………………………………………………………………….
8Full name, qualification and address of person before whom the declaration is made (in printed letters) / 8………………………………………………………………………………………………………………….
……….………………………………………………………………………………………………………….

Note 1A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment for a term of 4 years— see section 11 of the Statutory Declarations Act 1959.

Note 2Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959— see section 5A of the Statutory Declarations Act 1959.

A statutory declaration under the Statutory Declarations Act 1959 may be made before–

(1) a person who is currently licensed or registered under a law to practice in one of the following occupations:

ChiropractorDentistLegal practitioner

Medical practitionerNurseOptometrist

Patent attorneyPharmacistPhysiotherapist

PsychologistTrade marks attorneyVeterinary surgeon

(2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Australia, as a legal practitioner (however described); or

(3) a person who is in the following list:

Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public

Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955)

Bailiff

Bank officer with 5 or more continuous years of service

Building society officer with 5 or more years of continuous service

Chief executive officer of a Commonwealth court

Clerk of a court

Commissioner for Affidavits

Commissioner for Declarations

Credit union officer with 5 or more years of continuous service

Employee of the Australian Trade Commission who is:

(a) in a country or place outside Australia; and

(b) authorised under paragraph 3 (d) of the Consular Fees Act 1955; and

Employee of the Commonwealth who is:

(a) in a country or place outside Australia; and

(b) authorised under paragraph 3 (c) of the Consular Fees Act 1955; and

Fellow of the National Tax Accountants’ Association

Finance company officer with 5 or more years of continuous service

Holder of a statutory office not specified in another item in this list

Judge of a court

Justice of the Peace

Magistrate

Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961

Master of a court

Member of Chartered Secretaries Australia

Member of Engineers Australia, other than at the grade of student

Member of the Association of Taxation and Management Accountants

Member of the Australasian Institute of Mining and Metallurgy

Member of the Australian Defence Force who is:

(a) an officer; or

(b) a non-commissioned officer within the meaning of the DefenceForce Discipline Act 1982 with 5 or more years of continuous service; or

Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified Practising Accountants or the National Institute of Accountants

Member of:

(a) the Parliament of the Commonwealth; or

(b) the Parliament of a State; or

(d) a local government authority of a State or Territory

Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961

Notary public

Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service who is employed in an office supplying postal services to the public

Permanent employee of:

(a) the Commonwealth or a Commonwealth authority; or

(b) a State or Territory or a State or Territory authority; or

with 5 or more years of continuous service who is not specified in another item in this list

Person before whom a statutory declaration may be made under the law of the State or Territory in which the declaration is made

Police officer

Registrar, or Deputy Registrar, of a court

Senior Executive Service employee of:

(a) the Commonwealth or a Commonwealth authority; or

(b) a State or Territory or a State or Territory authority

Sheriff

Sheriff’s officer

Teacher employed on a full-time basis at a school or tertiary education institution