Fillable Aected Performance Consideration Student Form (UCOL)

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Aected Performance Consideration Student Form (UCOL)

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The Aected Performance Consideration Student Form (UCOL) form is 3 pages long and contains:

  • 1 signature
  • 8 check-boxes
  • 57 other fields

Country of origin: NEW-ZEALAND
File type: PDF

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Aected Performance Consideration
Student Form
Reason for APC application
Student details
This form is to be completed by a Unitec student when they were unable to prepare, attend, submit or do their best in an exam or
assessment that awards marks towards the nal grade, due to illness or other personal circumstances beyond their control.
Applying for an Aected Performance Consideration (APC) does not guarantee it will be granted.
This form must be submitted with:
• Proof of preparation or completed work, for example scanned documents, screenshots or photos.
• Evidence of the critical personal circumstances that impacted your study. A list of suitable evidence can be found on the
Unitec website APC page.
Submit this form and supporting documents to tkk@unitec.ac.nz
For more information see the Unitec website Extensions and Aected Performance Consideration (APC).
My address is correct in MyStudent portal Yes No
Due to personal circumstances beyond my control:
First name
Email
Address
Phone
Last name
Student ID number
I was unable to adequately prepare for an exam or assessment.
I was unable to attend an exam or assessment on the day.
I had to leave an exam or assessment early.
I am/was unable to submit the assessment by the due date.
I submitted on time or completed the exam or assessment but I was not able to do my best.
Aected Performance Consideration Student Form | 1 of 3
Aected Performance Consideration Student Form | 2 of 3
Course details
Programme
I am applying for Aected Performance Consideration (APC) for the following exams or assessments.
Course name Course code /
number
(eg. FSTU 3942)
Lecturer Date of exam
or assessment
Name of exam or
assessment
Date I believe I
can complete this
assessment
Assessment details
Explain what work you have completed so far for an assessment or what preparation you have done for an exam.
You are required to attach proof of preparation or completed work, for example scanned documents, screenshots or photos.
Aected Performance Consideration Student Form | 3 of 3
Type of evidence
Details about your supporting evidence
Declaration
The evidence I am attaching is (select one):
Completed APC Health Professional form
Who is the evidence from? (e.g. Doctor, nurse, counsellor, hospital)
I declare that:
Date Signed
Medical certicate
Person or organisation full name
Birth, death or court notice
Person or organisation email
Other evidence
Person or organisation phone number
The information I have provided is a true account of what happened. I will provide evidence to support this application.
I give my consent for any relevant details to be shared with the appropriate Unitec sta.
Statement of personal circumstances
Describe the personal circumstances that aected your ability to prepare or complete assessments or exams.
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Aected Performance Consideration Student Form (UCOL)

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Completed 21 June 2022

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