Enrolment Withdrawal Form Student Full Name * Date of Birth * Address * USI Number * Email * Phone * Withdrawal Date * Please indicate course * -- Please Select --CHC30121 Certificate III in Early Childhood Education and CareCHC30221 Certificate III in School Based Education SupportCHC40113 Certificate IV in School Age Education and CareCHC40221 Certificate IV in School Based Education SupportCHC50121 Diploma of Early Childhood Education and CareCHC50221 Diploma of School Age Education and CareCHC30121 + CHC50121 Dual Qualification in Early Childhood Education I paid my fees via * Upfront Payment Payment Plan Please indicate reason for cancellation * -- Please Select --Non ActivityCareer ChangePersonal/ Medical ReasonsPerformance IssueLoss of interestOther Other Reason Details * Are you currently doing your work placement? * Yes No If you are currently doing your placement you have to stop working from the withdrawal start date. Any Work placement or supervision provided during your withdrawal time will not be validated for your assessment. I am within the cooling off period * Yes No Your cooling off period is 7 days from your enrolment date. I will pay cancelation fees via * Upfront Payment Payment Plan Student Declaration: I acknowledge I have read the withdrawal and refund policy * I agree I acknowledge my withdrawal will be effective from the date selected * I agree I confirm the information provided is correct * I agree Captcha Submit If you are human, leave this field blank.
