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CSSE Assignment Extension Form

To request an extension, print out his form, complete both parts, attach any supporting documentation, and submit it to the lecturer as soon as possible. Please note that extensions will normally only be granted for a very good reason.

The information on this form is collected for the primary purpose of maintaining your assignment submission record correctly. Other purposes of collection include ensuring that your assignment is accepted, you receive the marks that you deserve. If you choose not to complete all the questions on this form, it may not be possible for the School to process your form (resulting in possible loss of marks for you) or contact you in the case of a problem. Personal information will be disclosed to no one except Monash staff. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal information, please contact the University Privacy Officer on 99056011.

Part A - retained by lecturer
SUBJECT CODE:    ________________________  SUBJECT:     ___________________________________________________________

STUDENT I.D. NO: ________________________ LECTURER:    ____________________________________________________________

SURNAME: ___________________________________________ OTHER NAMES: _________________________________________________

EMAIL ADDRESS:   __________________________________________________________________________________________________

ASSIGNMENT NO.:  ________________________            DUE DATE: ____________________________________________________

REASON FOR EXTENSION:   (Attach Medical Certificate or other documentation)

DATE SUBMITTED: __________________________________  REQUESTED DUE DATE: ___________________________________________


                                                    APPROVED NEW DATE: ____________________________________________

 --- cut --- --- cut --- --- cut --- --- cut --- --- cut --- --- cut --- --- cut --- --- cut --- --- cut ---

Part B - Returned to student. Copy to be attached to assignment when submitted to the Enquiries Office.


SUBJECT CODE: _________________________  SUBJECT:    ______________________________________________________________

STUDENT ID NO: _________________________ LECTURER:   ______________________________________________________________

SURNAME: _________________________________________ OTHER NAMES: ___________________________________________________

ASSIGNMENT NO: ________________________  DUE DATE :   _____________________________________________________________

EXTENSION:      Granted/Not Granted      APPROVED NEW DATE: _______________________________________________________

LECTURER'S SIGNATURE: ____________________________              DATE: _____________________________________________

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