APPLICATION FOR A SPECIAL TEST / EXAMINATION - LAW

APPLICATION FOR A SPECIAL TEST / EXAMINATION (LAW)
This application form must be completed and submitted electronically within 5 working days after the date of the test missed. We will not accept any hard copies.

Please complete a separate form for each test / Examinaiton-missed i.o.w. do not place two or more modules on one form.

Late applications will not be considered

STUDENT DETAILS
Full name *

First Name Last Name
Student Number *
Degree
Degree *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Contact Number *

- (021) Phone Number

TEST / EXAMINATION DETAILS
Module
Module *
Lecturer *
Date of test missed / to be missed *

- Day - Month Year
Date
Reasons for missing the TEST / EXAMINATION *

Medical Special Circumstances
Medical Certificate *

Browse Files

Cancel of
Proof of the relevantcircumstances *

Browse Files

Cancel of

Office use
Status
Additional Info
Date

- Day - Month Year
Signature (HOD)

Clear
Should be Empty: