(08) 8922 2222
[email protected]
PO Box 40471, Casuarina NT 0811
The Bullocky Point Education Precinct
Atkins Drive, The Gardens, NT 0820
Assessment Extension Application Form
Please Note:
1. All extensions can be negotiated up to the due date.
2. All applications for an extension must be based on a valid reason such as an illness, injury or
mishap beyond the student’s control.
3. All applications for extension must be supported by your parents / guardians or home school
support person.
4. Where possible some form of supportive documentation should be submitted to your
subject teacher with this application e.g. medical certificate, note from parents etc.
5. It is a student’s responsibility to meet an agreed negotiated deadline.
6. If a student does not meet this negotiated assessment deadline then this summative
assessment task will not be assigned a grade.
Student Name
Subject Code
Subject Name
NTSDE Teacher
Summative Assessment Item
Due Date
Reason for Extension
Any Supportive Documentation
(please attach if necessary)
Negotiated Extension Date
Student Signature
Date
Parent / Home School
Coordinator Name
Parent / Home School
Coordinator Signature
Date
NTSDE Teacher Name
NTSDE Teacher Signature
Date
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