Assessment Variation Application

THIS FORM TO BE PHOTOCOPIED IF YOU NEED TO MAKE APPLICATION FOR APPEAL/CONSIDERATION

 

BELLINGEN HIGH SCHOOL

ASSESSMENT VARIATION APPLICATION

NAME:  ………………………………………………………………………………………………….….

                                    (Surname)                                                       (Given Names)

 

SUBJECT:  ……………………..…..……  No. of UNITS:  ……….  CLASS:  ……………………….

 

NAME OF TEACHER:  ………….……………………………………………………………….……….

 

ASSESSMENT TASK:  ……………………….………………………………………………………….

 

DUE DATE FOR TASK:  ……………………………….

 

REASON(S) FOR APPEAL/CONSIDERATION:

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SUPPORTING DOCUMENTATION ATTACHED (please list)

 

MEDICAL CERTIFICATE from Dr.:.………………………………………………………….…

 

LETTER from PARENT/GUARDIAN

 

OTHER (describe):  …………………………………………………………………………………….

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SIGNATURE OF STUDENT:  ………….………….………………….  DATE:  ……………………

 

DECISION

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THIS FORM MUST BE SUBMITTED TO HEAD TEACHER OF SUBJECT CONCERNED.  PLEASE READ ‘SCHOOL BASED ASSESSMENT – GENERAL SCHOOL POLICIES’ AND ‘ASSESSMENT TASK APPEALS’ IN YOUR ASSESSMENT BOOKLET.

 

NO CONSIDERATION CAN BE GIVEN IF THESE POLICIES ARE NOT FOLLOWED