Adverse Circumstances Request

Request for Supporting Documentation for Adverse Circumstances

This form is for students to request supporting documentation for:

extension of time for assessment item/s
rescheduling an exam
mandatory attendance requirements.

The supporting documentation can be used in an Adverse Circumstances application.

If you require other documentation, such as rescheduling a placement, remission of fees, leave of absence, you will need to speak with a Wellbeing Advisor. To do this, please request an appointment using the Student Wellbeing Appointment Request Form.

Important Information:

Please note - A Statutory Declaration is acceptable supporting documentation for health grounds, compassionate grounds, hardship or trauma (Clause 62, j of Adverse Circumstances Policy). A statutory declaration is a written statement which a person swears, affirms or declares to be true in the presence of an authorised witness – usually a Justice of the Peace (JP). You can download the statutory declaration form. See here for how to find a Justice of the Peace.

You may only request documentation from Student Wellbeing using this form once per semester. After this, you will need to request an appointment to meet with a Wellbeing Advisor using the Student Wellbeing Appointment Request Form. The Wellbeing Advisor will be able to assess your request for documentation and discuss options for support for the issues impacting on your study.

As per the Adverse Circumstances policy (Section 4, 18), Aboriginal and/or Torres Straight Islander students do not need supporting documentation for Cultural Leave or Sorry Business. Please submit your adverse circumstances application via MyHub without documentation. If you are requested to validate cultural leave contact Wollotuka staff or email Wollotuka@newcastle.edu.au for support.

Students enrolled in the Bachelor of Medicine - Joint Medical Program, or the Bachelor of Medical Science and Doctor of Medicine, should refer to the Joint Medical Program Manual for advice on the required documentation.

You may use the translate button in top right to view the form in other languages. Please complete any written responses in the form in English.

Eligibility

Is your assessment item worth 30% or more of your final result? (For Open Foundations, Yapug, NU Chance, Diploma the cut off is 20% or more) *

Yes, they are worth 30% or more (20% for Open Foundations etc.)No, they are worth less than 30% (20% for Open Foundations etc.)

If your assessment is worth less than 30% and no specific instructions have been provided then you should apply in writing directly to your Course Coordinator, preferably via email from your student email account.

Your Course Coordinator may ask you to supply further information or documentation to substantiate your request.

Students in Open Foundations, Yapug, NU Chance or Diploma should apply to their Course Coordinator directly when the assessment is worth less than 20% of the final grade.

See here for more info.

Do you have a current Reasonable Adjustment Plan from AccessAbility? *

Yes, I have a Reasonable Adjustment Plan including additional timeNo, I don't have a Reasonable Adjustment Plan

If you have a current Reasonable Adjustment Plan (RAP) from AccessAbility which includes additional time for assessment tasks, then you do not require further supporting documentation.

You can attach your Reasonable Adjustment Plan directly to your Adverse Circumstances application.

Please note that RAPs cannot be used to reschedule exams in the supplementary exam period.

How many times have you used this form to request supporting documentation from Student Wellbeing this semester (or trimester)? *

This is my first time completing a request form this semester/trimesterI have made one or more previous requests this semester/trimester

You may only use this form to request supporting documentation once per semester/trimester.

If you have already made a request, you will need to meet with a Wellbeing Advisor to request documentation. To request an appointment with a Wellbeing Advisor, please complete the Student Wellbeing Appointment Request Form.

Are you an Aboriginal and/or Torres Straight Islander student requesting documentation for Cultural Leave or Sorry Business? *

YesNo

As per the Adverse Circumstances policy (Section 4, 18), Aboriginal and/or Torres Straight Islander students do not need supporting documentation for Cultural Leave or Sorry Business.

Please submit your adverse circumstances application via MyHub without documentation, and if you are requested to validate cultural leave contact Wollotuka staff or email Wollotuka@newcastle.edu.au for support.

Details

Date of request *

First Name *

Last Name *

Student Number *

Phone number *

University Email Address *

Program or Degree *

Type of enrolment *

Domestic StudentInternational Student

What school is your program attached to? *

On what grounds are you seeking an extension? *

EXPLANATIONS FOR GROUNDS FOR EXTENSION

Health grounds - includes physical or psychological health issues, such as Anxiety

Compassionate grounds - for example, the death or serious injury of a close family member or friend

Hardship grounds - for example, sudden loss of employment; family breakdown; or severe disruption to domestic arrangements. Hardship does NOT include difficult academic workload.

Trauma grounds - for example, impact of crime or accident; impact of natural disasters

Cultural days or Sorry Business - 'Cultural Days' can include important cultural events of any cultural heritage.

Unavoidable commitments - for example, volunteer firefighters or student reservists. Does NOT include work commitments.

Adverse Circumstances DO NOT include:

misreading the Course Outline or examination timetable
usual work commitments
travel plans
being unaware of the assumed knowledge requirements for your course

As per the Adverse Circumstances policy (Section 4, 18), Aboriginal and/or Torres Straight Islander students do not need supporting documentation for Cultural Leave or Sorry Business.

Please submit your adverse circumstances application via MyHub without documentation, and if you are requested to validate cultural leave contact Wollotuka staff or email Wollotuka@newcastle.edu.au for support.

Please provide a brief description of the situation impacting your current assessment item/s *Note - This information will NOT be included in your supporting documentation

Date your assessment items were first impacted by the situation/circumstances above *This will be shown on your supporting documentation. See below for tips.

End date of impact of situation/circumstances *This should be the date by which you can submit the assessment item. Usually 1-14 days duration of impact.

The total duration of impact should be similiar to the number of days additional time you are requesting.

Adverse circumstances typically cover short-term extensions (e.g., days and weeks). If you have been impacted by a condition over a longer period of time then consider applying for a Reasonable Adjustment Plan from AccessAbility.

I am requesting documentation for (check all that apply): *

Additional time for assessment itemsReschedule an exam or quizMandatory attendance requirements

If your request is not for one of these reasons, you will need to speak with a Wellbeing Advisor. Please use the "Request an Appointment"

Provide details of all assessment items you require additional time for: *Format: Course Code, Assessment Task Name, Assessment weighting, Original Due Date, Number of days extension required

Assessment item 2Format: Course Code, Assessment Task Name, Assessment weighting, Original Due Date, Number of days extension required

Assessment Item 3Format: Course Code, Assessment Task Name, Assessment weighting, Original Due Date, Number of days extension required

Assessment Item 4Format: Course Code, Assessment Task Name, Assessment weighting, Original Due Date, Number of days extension required

Assessment Item 5Format: Course Code, Assessment Task Name, Assessment weighting, Original Due Date, Number of days extension required

Additional Assessment Items

Are you currently seeing a Counsellor at Student Wellbeing? *

YesNo

Would you like meet with a Wellbeing Advisor to discuss support for the issues impacting your study and/or wellbeing? *

YesNo

We encourage students to consider seeking support for issues impacting on their study or wellbeing.

To request an appointment with a Wellbeing Advisor or Counsellor, please complete the Student Wellbeing Appointment Request Form.

If you have any comments or feedback about this online request form, please let us know:

Your Privacy and Confidentiality Rights Explained - PLEASE READ CAREFULLY

Thank you for contacting the University of Newcastle Counselling and Psychological Services (CAPS).

CONFIDENTIALITY

The University is committed to the protection of your personal information. You may need to provide personal information when accessing our services and talking to a Wellbeing Advisor or a Counsellor either in person, when completing paperwork, on the telephone or online.

The University of Newcastle CAPS will not discuss your personal information with any persons outside of CAPS, except in the following situations:

When you have provided your consent;
Where the University of Newcastle has a legal obligation to do so;
Where it is necessary to manage the risk of an immediate threat of harm to an identifiable person or persons, including yourself, that can be averted only by disclosing information;
When CAPS staff are consulting or in the course of supervision or professional training (in this instance your identity and the identity of other parties involved will be concealed).

Personal information you may provide to the counselling service, including information supplied to online programs such as 'thedesk', eCliPSE, Zoom and during group programs may be collected, stored, used and disseminated by the University, for the purpose of assisting in the University's delivery of and research in respect of counselling services. Your identity, and the identity of any parties involved, will be concealed to protect your privacy.

The University of Newcastle abides by the Privacy and Personal Information Protection Act (NSW) 1998, the Health Records and Information Privacy Act (NSW) 2002 as set out in the University’s Privacy Management Plan in the collection, storage, access, use and disclosure of your personal and health information.

ONLINE AND TELEPHONE COUNSELLING

The University of Newcastle Counselling and Psychological Services also offers counselling services via telephone or online.

Our online counselling services are offered using the digital platforms: Zoom and Skype.

Zoom is a free, high quality video conferencing program, which allow users to see and hear each other using a computer or handheld device that is equipped with a camera and a microphone. The University has adopted encryption processes and each Zoom meeting is password protected to reduce the risk of access by parties other than those who have been invited and to prevent potential electronic eavesdropping.

For beneficial telephone or online counselling services, you will need access to a quiet and private area away from distractions and the risk of your conversation being overheard.

For online counselling use an appropriate device with a camera, microphone and speakers, and a reliable internet service.

In consenting to using the online services you acknowledge these risks and consent to proceed with counselling and support on this basis.

LIMITATIONS OF SERVICES

Whilst the University takes all reasonable steps to ensure security in providing our services, due to reasons outside our control, the University of Newcastle Counselling and Psychological Services cannot guarantee the privacy or security of session content or communication conducted via online services (including telephone services).

There is potential that videoconferencing sessions or phone calls could be intercepted by others and communicating via these mediums cannot be guaranteed 100% secure. To ensure up to date security protocols, we recommend that you use a current version of Zoom and to ensure that your computer or other electronic device is subject to appropriate password security and up-to-date anti-virus software. Where possible, do not use public wi-fi as this is not a secure service.

Additional factors to consider include:

Online counselling may lack visual and/or audio cues, which may increase the possibility of misunderstandings.
Online counselling may have disruptions or delays in service and quality of the technology used.

It is important to consider beforehand whether this service is appropriate for your needs before proceeding.

CONFIRMATION OF INFORMED CONSENT

By engaging in online counselling services, I agree to the following:

To provide the counsellor with my location at the beginning of the session so that the online counsellor can get help in the case of an emergency.
To engage in sessions only from a private location where I will not be overheard or interrupted.
To attempt to connect to via private internet connection (i.e., not a public Wi-Fi)
To ensure that the computer or device I use has updated operating and anti-virus software.
I will not record any sessions, nor will the counsellor record sessions, without obtaining prior written consent.

I have read and understood the above statements *

What will happen next?

Our clinicians will review your information and be in touch via phone and/or email within two business days.

Please check your university email account and answer your phone.

You do not need to wait until you have documentation to submit your Adverse Circumstances application. You can upload the supporting documentation to your application up to three days after you have submitted it.

If you have any concerns about receiving your documentation, please contact counselling@newcastle.edu.au

If you require support outside of business hours, you can contact the University Crisis Line on 1300 653 007 / SMS: 0488 884 165.

Staff Response to Request

Date of staff response *

Clinican Name *

Have you checked snapforms for repeated requests? (optional) *

YesNo

Do you approve the request for supporting documentation? *

YesNo

Casenotes related to Eligibility

Welfare and Risk

Level One examples include:

stress
recent physical health issues
grief and loss
family issues
relationship breakup

Level Two examples include:

mental health issue
financial strain
recent hospital admission for mental health

Level Three examples include:

current or recent thoughts of suicide or self harm
recent sexual assault or trauma
currently homeless
Psychotic symptoms
domestic violence
serious mental illness

Casenotes on risk or level of concern

Action taken by staff

Sent email advising student not eligable for supporting documentation, and alternative optionsSent email with supporting letter and self help resources (appropriate for level 1)Sent email with supporting letter, resources, and recommended they contact student wellbeing to book appointment (appropriate for level 2)Sent email with supporting letter, resources, and advised that Student Wellbeing will be in contact to book welfare check (Level 3)Student added to waitlist for welfare checkCustomised support letter provided to student (detail reason below)Other (please describe below)

Casenotes on any additional actions taken

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