APPLICATION FOR
SPECIAL CIRCUMSTANCE
Student Name: ________________________________
Student Number: ______________________________
EPT Subject: __________________________________
The Professional Experience Unit allows students to document any Special Circumstances which may
impact on their placement that fall under allowed categories. Only legal, medical, carer and CSU
Residential Advisor matters will be considered.
Special Circumstances will not be considered without documentary evidence. Only applications
for Special Circumstances with adequate supporting documentation will be forwarded on for
consideration by senior staff. Please note that submitting an application for Special Circumstances
does not indicate that it will automatically be granted. Granting “Special Circumstance” is only
awarded to students with absolute need and genuine circumstances.
Any condition, medical or otherwise, which may affect the pre-service teacher’s welfare during a
professional experience placement, must be notified to the Professional Experience Unit. This
information is confidential, and is not released to schools/early childhood services by the PEU.
Each application is considered on a case by case basis and meeting a request depends on the
availability of schools or early childhood settings in a preferred area.
I have read, understood and agreed to the above criteria regarding the application of Special
Circumstance
I wish to apply for special circumstances for the following reason:
Carer responsibilities - must provide copy of birth certificate/s
Legal – must provide evidence such as AVO
Student Advisor – must provide letter confirming position of student advisor
Medical – this must be a pre-existing medical condition that specifically prevents that student’s
capacity to carry out placement or requires the student to attend regular medical appointments.
Certificates must explain what the student is able/not able to do and must be accompanied by
CSU’s medical certificate which the doctor must complete. Medical certificates will not be
accepted after the release of placement information.
I have attached appropriate supporting documentation for my claim of special circumstance
All information I have provided is true and correct and I acknowledge that any misleading or false
information may result in my placement being cancelled or being moved to another location.
If my application is approved, my preferred town/city location (not school/service) is:
___________________________________
Signed:
Date: __________________
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