Application for Placement Extension / Change Application for Placement Extension / Change Applications must be applied for in advance of the specified due date. Extensions will only be granted on the following grounds, at the discretion of the Placement Coordinator. Supporting documentation may be required. Documented illness: medical certificate must be provided Compassionate grounds: those situations for which compassionate leave is normally granted in employment Documented hardship or trauma Unexpected Work/Placement commitments Change in supervision Inadequate resources Other circumstances beyond the candidate’s control Note: If you are on placement at more than one location and need to extend all location, you need to submit a placement extension per location. Personal Details First Name * Family Name * Student ID: * Select Course * Bachelor of Psychology and CounsellingMaster of Psychology (Clinical Psychology)Doctor of Psychology (Clinical Psychology)Post Registration (Clinical Psychology)Graduate Diploma of Counselling and PsychotherapyMaster of Counselling and PsychotherapyMaster of Professional Psychology (MPP) Select Unit * CLN560 (Placement A/B)CLN662 (Placement C)CLN663 (Placement D)CLN761 (Placement E)CLN861 (Placement F)CAP361 (Placement 1)CAP461 (Placement 1)CAP561 (Placement 2)MPP560 - MPP562 (Placement 1)CLP664/CLP674 (Placement A)CLP665/CLP675 (Placement B) What year did you commence this Unit? * 2025 2026 2027 Supervisor Name * Supervisor Email * Student Type: * Domestic International/Overseas Will you require an updated Confirmation of Enrolment (COE) due to Visa conditions? * Yes No What are you applying for? * Placement Extension (Placement still active) 7 Day Placement Documentation Only Extension (Placement has finished i.e. all hours accrued, all assessment requirements submitted) only uploading of finalised documents outstanding including waiting on AHPRA approvals if app) Placement Change / Cancellation Placement Extension Name of Agency/School * Is your placement supervisor aware of your intended extension? * Yes No Is your placement representative aware of this intended extension? * Yes No Name of placement representative: * Note: this is the person onsite at the agency/provider, not your CMI placement coordinator. Placement Representative email: * Original Deadline * Requested (Extension) Deadline * How many extra days do you require to attend your placement? * Note: just provide total extra days you'll be attending placement e.g. 4 days (that would mean 2 days at placement per week over 2 weeks) Do not include days in between. Are you using PracSuite for this Placement? Yes No This is a CMI PracSuite account that will have been requested by your Placement Coordinator for you to use throughout your current placement NOTE: PracSuite is the system where you create and store your client case notes / patient file throughout your placement. Not all students require an account. This is dependent on your placement agency/school. Grounds for extension * You understand this extension may incur a fee. You will be advised once the extension has been processed. * I understand Click here for more on fees and fee waivers https://my.cairnmillar.edu.au/knowledgebase/extension-enrolment-fees-and-waivers/ Are there any administrative reasons for your extension? If yes, please state below: * eg. were the circumstances resulting in the need for an extension out of your control? If not applicable, please type 'N/A' Supporting Documentation (if applicable) Drop a file here or click to upload Choose File Maximum file size: 5MB Accepts .jpg, .png, .pdf Placement Change / Cancellation Placement Change / Cancellation * Change of Placement Agency / School Placement Cancellation / Withdrawal Change of Supervisor Current Agency / School * New Agency / School * Current Agency / SchoolStart Date * Current Agency / SchoolEnd Date * New Agency / SchoolStart Date * New Agency / SchoolEnd Date * Name of New Supervisor * New Supervisor's Email * Reason for Change * Date of Cancellation / Withdrawal * Please also complete and submit this Withdrawal form Placement Coordinator has approved this? Supervisor has approved this? 7 Day Placement Document Extension (Placement has finished) Name of Agency/School * What Date did you complete your placement hours? * Requested Extension Date * Reason for Document Extension * Are you using PracSuite for this Placement? * Yes No NOTE: PracSuite is the system where you create and store your client case notes / patient file throughout your placement. Not all students require an account. This is dependent on your placement agency/school. You understand this extension may incur a fee. You will be advised once the extension has been processed. * I understand Confirm that you understand that if my extension goes beyond the requested extension date and exceeds 14 days, you will be need to reapply for a further extension and will be required to complete a Placement Extension Agreement form that will require signatures of each of the signatories within my original Form A contract. * I understand Confirm that you understand that an additional enrolment may be required for extensions that require extra supervision being sourced (Note: this does not relate to Document only requests or short extensions i.e. few days). You will be emailed specific information if further enrolment is required and must reply within 5 workings days (or before census if sooner) if you have any queries on the enrolment advice given. * I understand Submit If you are human, leave this field blank.