Request for Extension
Please use this form to apply for an extension. Please be reminded that extension approvals are entirely dependent on your progress on the course. You are further advised that the maximum extension permissible through any single application is 1-month from your latest close of study date. There is no limit to the number of extensions you can request, however, approvals depend upon your progress on the course.
Your Name
*
First Name
Last Name
Email Address
*
example@example.com
Mobile Number
*
Select the course for which you are lodging this extension application
*
Certificate III in Business
Certificate III in Individual Support (Disability)
Certificate III in Community Services
Certificate IV in Mental Health
Certificate IV in Mental Health Peer Work
Diploma of Community Services (Case Management)
Diploma of Mental Health
Provide a clear and detailed reason for why your extension should be considered (maximum 350 words)
*
0/350
I declare
All the information provided in this extension request form is true and correct;
I understand that lodgement of an extension request does not provide a guarantee of Close of Study extension;
I understand extension approvals are dependent on my progress on the course, and the relevant trainer/assessor has the delegation to make this decision;
I understand the maximum possible extension permissable through any single application is 1-month from the date of the latest Close of Study date.
Student signature
*
Trainer/Assessor making this extension decision
*
training@selectability.com.au
Please provide an extension outcome
*
Approved
Declined
Provide an extension date
*
/
Day
/
Month
Year
Date
Trainer/Assessor Signature
*
Submit
Current Close of Study Date
/
Day
/
Month
Year
Date
Proposed extension end date
/
Day
/
Month
Year
Date
Reason for extension request
Medical
Work commitments
Home commitments
Change of circumstances
Difficulty securing suitable child care
Other
Total number of days extension
Date
/
Day
/
Month
Year
Date
Trainer/Assessor comments
Who is making the request?
Student
selectability Training staff member
Original Close of Study Date (COS)
/
Day
/
Month
Year
Date
Staff Email
New Close of Study Date (COS)
/
Day
/
Month
Year
Date
Staff Member
First Name
Last Name
Should be Empty: