Student Study Leave Request

SELF ASSESSMENT FORM

First name*

Last Name*

Year Level*

Select or enter value

Akina Group*

Do you fit the criteria to qualify for study leave?*

• All internal standards offered complete. • Enough credits to have passed Level 1, 2 or 3 prior to study leave.

Yes

No

Do you have enough external credits to pass, if you have not yet achieved Level 1, 2, or 3 with internal credits?*

Yes

No

Unsure

Do you need more time at school to complete internals in order to pass?*

Yes

No

Which three subjects do you need the most support with?

NCEA Level 1*

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NCEA Level 2*

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NCEA Level 3*

Select or enter value

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