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CRICOS No: 00244B QLD; 02225M NSW; TEQSA PRV12081 Date Modified 13.11.2019
This form is to be used by students on Conditional Academic Standing who are required to
Show Cause why they should not be excluded in accordance with the Academic Standing,
Progression and Exclusion procedure:
http://policy.usq.edu.au/documents/13566PL.
STUDENT DETAILS
Full Name
Student
Number
Program
Name
Program
Code
SHOW CAUSE SUBMISSION INSTRUCTIONS
1. Attach a detailed statement explaining the grounds on which you believe that your enrolment should not
be cancelled. Your statement must include the following:
• the factors outside of your control which contributed to your failure to meet the academic
requirements of your program;
• the steps that you have taken to negate these factors in future;
•
if you have previously had special requirements imposed by your faculty as a condition of admission,
readmission or continuation in a program, an explanation of how you have satisfied these
conditions;
• if you have had an Academic Intervention Strategy, an explanation of how you have satisfied the
recommended strategies. See the next section – Academic Intervention Requirements.
2. Sign and date your attached statement.
3. Attach all other available documentary evidence (eg, medical certificate, letter from counsellor, notice
from employer etc) to support any claims you make.
ACADEMIC INTERVENTION REQUIREMENTS
What are the key factors
outside your control that
have contributed to your
failure to meet the
academic requirements of
your program?
Explain the steps that you
have taken to negate these
factors in future.
Attach a copy of your
Academic Intervention
Strategy and explain how
you have satisfied the
recommended strategies.
Attach a copy of your
Academic Success Plan and
explain how you have
satisfied the recommended
plan.
SHOW CAUSE SUBMISSION
CRICOS No: 00244B QLD; 02225M NSW; TEQSA PRV12081 Date Modified 17/09/2015
If applicable, what are the
special requirements
previously imposed by your
faculty as a condition of
admission, readmission or
continuation in a program?
Explain how you have
satisfied these conditions
STUDENT ACKNOWLEDGMENT
Student
Signature
Date
FACULTY DECISION (OFFICE USE ONLY)
Date Received
Was the submission received within 20 University Business Days of
receipt by the student of the Show Cause notice?
Yes
No
Continued enrolment permitted
with conditions
Continued enrolment not
permitted
Date of
Decision
Conditions of Enrolment or Reason/s Denied
Executive Dean or Nominee Name
Signature of Executive Dean or Nominee
Is the program of study being undertaken a double degree?
Yes
No
Executive Dean or Nominee Name of second
faculty
Signature of Executive Dean or Nominee of
second faculty
After completion, return this submission and supporting documentation in hard copy to your
Faculty, or email to usq.support@usq.edu.au
, within twenty (20) University Business Days of
receipt of the Show Cause notice.
USQ collects, handles, uses, discloses and stores information about you and the choices available to you for provision of
products and services selected by you throughout your learning journey. Not all of the information is personal information
under the Privacy Act 2009 (Qld). To comply with legal and administrative obligations information is disclosed to
Commonwealth and State agencies. Personal information will not be disclosed to third parties other than a USQ approved
educational services agent, partner or organisation who provides sponsorship to you for your studies, without your consent
unless required or permitted by a law. Where we disclose to a third party we endeavour to ensure they are bound by the
same requirements as USQ with respect to personal information. Transfer of personal information outside Australia may
occur. You have the right to access your personal information and if you wish to inquire about the handling or seek access
to your personal information you can contact the USQ Privacy Officer (privacy@usq.edu.au
).
13-Nov-2019
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Completed 4 February 2021

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