Illness Misadventure Form

This form should be completed if student believes that circumstances occurring immediately before or during an exam, and which were beyond control, diminished examination performance.

Make sure to complete and attach the Medical Certificate form available under Forms on Moodle.

I am submitting this form regarding*

Past assessment(s) Future assessment(s)

Name*

First Name

Last Name

Class*

Email*

Your email will be used to communicate the outcome of your request.

Assessment Task Details

Course*

Select the correct course from the list.

Nature*

Weight (%)*

Date/Time*

Description of the Circumstances

Giving reasons please clearly describe the circumstances that you believe diminished your performance.

Attachments*

No File Chosen

File uploads may not work on some mobile devices.

Please upload supporting evidence that may support your application. These may be the Amity College Medical Certificate Form, prescription, statement from a teacher, etc. Failure to present supportive evidence may result in your application being rejected.