Application for Special Adjustments to Central Examinations form

When NOT to use this form

Do not use this form if any of the following applies;

it is less than 24 hours until your exam
you cannot attend exams on the days and times they are currently scheduled (due to illness or other commitments)
you do not have medical documentation to verify your need for special adjustments.

if the application is relevant to a School-based assessment item
you have a current Education Inclusion Plan and the request for special adjustment relates to the disability/health condition documented in this plan
you have a long term health condition or disability, adjustments for which can be provided for in an Education Inclusion Plan developed by Disability Services, and it is before the end of week 9 (in this case, you must arrange to meet with a Disability Advisor before the Wednesday of week 9.)

If you require special adjustment/s for end of semester, central examination/s due to an unexpected (recent) occurrence, which has caused a temporary medical condition, for example, a broken bone resulting from an accident. If your application is successful your personal timetable will be updated overnight and you will receive a confirmation email from the central examinations team.

How to use this form

complete all Sections A, B and C of this form
attach an original medical certificate

Complete the Special Adjustments form below:

If you are experiencing difficulties submitting this form, please try opening this page and submitting the form again using Google Chrome or Firefox, or please contact examinations@acu.edu.au

Does this application for special adjustments relate to a disability or health condition currently provided for in an Education Inclusion Plan from Disability Services? * Yes No

Section A - Personal Details

Student ID *

Last Name *

Given Name/s *

Course *

Campus *

Telephone (Business Hours) *

Mobile Number *

ACU Student Email Address *

Section B - Details of Unit Examination/s requiring adjustment

You must enter all details for at least one exam. Important: Exam date must be more than 24hrs after the application date.

Unit Code 1 *

Unit Title 1 *

Exam Date 1 *

Unit Code 2

Unit Title 2

Exam Date 2

Unit Code 3

Unit Title 3

Exam Date 3

Unit Code 4

Unit Title 4

Exam Date 4

Section C - Requirements due to a Temporary Injury or Physical Condition

Do you have a temporary physical condition or injury but you believe an examination adjustment will allow you to sit your exam in the main exam round?

In the box below, suggest the adjustments that are necessary because of your injury/condition.

For example:

Injury to your writing hand:

permission to answer the examination paper on a PC
5 or 10 minutes additional writing time

Injury to your leg:

permission to sit the exam in a wheelchair accessible venue due to mobility issues (on crutches)

Reason for your application *

Attach evidence of your condition and supporting documentation justifying your adjustment:

Note: Attach up to four (4) items; each file that you attach can be no larger than 3Mb. To reduce the file size, save the file with a ".jpg" extension before attaching.

Note: If you are unable to successfully attach electronic copies of supporting documentary evidence, you will need to submit those copies to the AskACU Hub on campus, along with the email confirmation you will receive after submitting this form.

PLEASE NOTE: If this application is relevant to an end of semester, central examination but it is less than 72 hours prior to the day of the relevant scheduled examination, we may not be able to accommodate your SA conditions in time. In this case, you will be required to sit a deferred examination.

By submitting this application I declare that the information supplied herein is correct and complete and that the documentary evidence supporting this application is authentic. *

I authorise the University to obtain further information with respect to my application and, if necessary, to investigate the legitimacy of the documentation I have provided. I acknowledge that the submission of incorrect or false information may result in *

If you are experiencing difficulties submitting this form, please try opening this page and submitting the form again using Google Chrome or Firefox, or please contact examinations@acu.edu.au

Application for Special Adjustments to Central Examinations form

When NOT to use this form

When to use this form

How to use this form

Section A - Personal Details

Section B - Details of Unit Examination/s requiring adjustment

Section C - Requirements due to a Temporary Injury or Physical Condition

Attach evidence of your condition and supporting documentation justifying your adjustment:

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