Barrenjoey High School
ILLNESS, ACCIDENT MISADVENTURE
STUDENT
APPEAL FORM
This form is to be used for any Assessment Task or Exam that is not completed OR not submitted by a student on the specified date.
Student
Name:
_______________________________
Date: ___/___/____ Teacher: __________________________ Faculty:
___________________ Class:
_________ Task
/ Exam ______________________________________ Date of Task:
___/___/____ Reason
for Appeal: _________________________________________________________
Doctor’s Certificate / Statutory Declaration attached: Yes No
Working
Notes (where applicable) attached:
Yes No Requirement: Same Task /
Exam Different Task / Exam
Proposed
Date: ___/___/____
Proposed Time: ____________________ Note: If this involves missing a period/s
in another subject/s, the consent of the teacher/s involved must be indicated
below. Teacher’s
Signature: __________________________________ Period: __________________ Teacher’s
Signature: __________________________________ Period: __________________
Head Teacher’s comments on appeal: _________________________________________________
Head Teacher’s Signature: ___________________ Student’s Signature: _____________________
Parent/Caregiver’s
Signature: ______________________________________________________
Alternative
Task Same Task Estimate
Zero Percentage
of marks to be deducted
_________________ Comment:
________________________________________________________________ Signature:
___________________________________ (Convener of Panel)