Derived Exam Rating Application & Consent Form

SENIOR SECONDARY EXTERNAL ASSESSMENT

Complete this form if you are seeking exemption from an exam, either in whole or part. It will be used as evidence towards your application to have derived exam ratings applied to your results.

Section A: Student Information (student to complete)

TASC Id (Eg. 06A12345) *

Date of Birth *

Given Name *

Family Name *

Previous Names

Email Address *

Contact Number *

Address Line 1 *

Address Line 2

City

Country *

State *

State

Postal Code

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