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MAITLAND HIGH SCHOOL - Millennium

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<strong>MAITLAND</strong> <strong>HIGH</strong> <strong>SCHOOL</strong><br />

PRELIMINARY / HSC CERTIFICATE<br />

ILLNESS / MISADVENTURE APPEAL APPLICATION<br />

This form must be completed and returned within one school day.<br />

Student: __________________________________________________________<br />

Year: _______________<br />

Subject: ______________________________ Course: ______________________ Units: _______<br />

Assessment Task: _____________________________________________________________________________<br />

Due Date: _______________ Date of Application: _______________ Date Returned: ______________<br />

Reasons for failure to meet requirements by / on due date: _____________________________________________<br />

____________________________________________________________________________________________<br />

____________________________________________________________________________________________<br />

____________________________________________________________________________________________<br />

Medical Certificate: Is attached / Is not attached / N/A (cross out as necessary)<br />

Further supporting evidence: ____________________________________________________________________<br />

Signed: ______________________________ (Caregiver)<br />

________________________________ (Student)<br />

Teacher’s Recommendation: ____________________________________________________________<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

Signed: _____________________________________________<br />

Date: ______________________<br />

Head Teacher’s Recommendation: _______________________________________________________<br />

____________________________________________________________________________________<br />

Signed: _____________________________________________<br />

Date: ______________________<br />

This form must be forwarded to the Appeal Committee.<br />

Appeals Committee Recommendation: ____________________________________________________<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

BOS Contact: __________________________________________ Date: ______________________<br />

Copies to: a) Faculty Head Teacher c) Principal / Deputy Principal<br />

b) BOS Contact d) Year Adviser<br />

Note: If this alters assessment ranks all affected students must be notified.<br />

_____________________________________________________________________________________________________________________<br />

Maitland High School 2011 Preliminary Assessment Booklet

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