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School of Education Professional Experience 2011

Special Consideration for Secondary Professional Experience Placement CONFIDENTIAL

I provide the following information for my Focus Day variation request:

Name:

Student ID:

I am currently enrolled in the Unit: (Please circle or highlight relevant unit.)

101704 Professional Experience I; or 100978 Professional Experience II

I am studying in one of the following modes: (Please circle or highlight relevant mode.)

• Accelerated (2 semesters) • Full time (3 semesters) • Part time (4+ semesters)

I provide the following reason for requesting special consideration during my in-school professional experience placement: I attach supporting documentation (if applicable), eg. a doctor’s certificate.

Pre-service Teacher’s signature:

Date:

OFFICE USE ONLY APPROVED/NOT APPROVED:__________________________________________

COMMENTS:_______________________________________________________

Name & Signature: _________________________________________________

Date:_________________

Action taken by PE Unit_________________________________________________________

Please submit to the Professional Experience assignment box 38.