Student ID
Given Name
Family Name
Declaration by the student
By submission of this Declaration I hereby consent to relevant information being provided by my nominated authorised
professional person and agree verification of this certificate can be provided if requested by The University of Western Australia. I
understand I must retain the originals of any documents submitted in support of a special consideration request and the
University may require the originals to be supplied at any time during my candidature until my degree has been conferred, or my
candidature otherwise terminated.
I understand that pre-arranged holiday travel, social events (such as birthdays), general sporting activities, usual rostered work,
student’s study load, misunderstanding/misreading of an examination timetable or assessment deadline, computer and/or IT
(Information Technology) failure are not grounds for special consideration.
Declaration by authorised professional
As an authorised professional and by signing this Declaration, I confirm I have reviewed the Application for Special
Consideration and verify the reason outlined below as being the impact on the student’s capacity to attend classes/tutorials;
complete assessment requirements; or be unable to attend their scheduled examination in accordance with the information
outlined in their Application for Special Consideration.
Date range for impact of situation From To
Grounds for Special Consideration
Required evidential support
Misadventure and non-medical related
circumstances/obligations or other factors
impacting on study
Special Consideration Declaration signed by authorised professional/
person (eg. UWA staff member, Religious leader, police officer,
recognised Elite Athlete or Arts representative, registered social
worker) dependent upon the nature of the obligation
Elite sport/Art commitment
Matter of undisclosed nature
Provide additional comments to support the request and attach supporting documents if relevant
Contact number
details authorised person
Position Title
I declare that I am not a family member and do not have a close or personal relationship with this student. I
authorise The University of Western Australia to contact me or my office to confirm authenticity of this document.
Cultural or religious reasons
email address
Please save this document with the Student name and ID in the document name
*Date the declaration was written and issued