Student-Initiated Student Support Request Form

Date

Student first name(s)

Student last name

Student Number

Date of birth

Student name (concatenated)

Email address

Year

Semester

Semester 1Semester 2

	Yes	No
Are you of Aboriginal and/or Torres Strait Islander origin?
Are you from a non-English speaking background?
Do you have a disability / mental health issues / chronic health issue?

Area of requested support

Academic performanceNon-completion of assessmentsCourse progressRepeated unit withdrawalsStudy skillsPastoral concernsDisability / mental health / chronic health concernsClass engagement / participationRepeated assignment extension requestsAttendanceOther

Details of above concern or issue

Mary Andrews College, Level 1 St Andrew's House, 464-480 Kent Street, Sydney NSW 2000

Ph 1300-590-531         Email macmin@mac.edu.au        Website www.mac.edu.au

Page 2

Current impact on your studies

What support has been tried so far (if any)?

Secondary life events or issues impacting on your wellbeing (if any)

What would you to see happen to support you further at MAC (if known)?

After you press the submit button below, your response to this form will be sent to our Dean of Students (deanofstudents@mac.edu.au).

Mary Andrews College, Level 1 St Andrew's House, 464-480 Kent Street, Sydney NSW 2000

Ph 1300-590-531         Email macmin@mac.edu.au        Website www.mac.edu.au

Contact Information

Anglican Deaconess Ministries Limited Level 1 St Andrews House 464-480 Kent St Sydney NSW 2000

T +61 1300896530 www.deaconessministries.org.au ABN 11 069 533 482