Enrolment Withdrawal Form

Student Full Name

Date of Birth

Address

USI Number

Email

Phone

Withdrawal Date

Please indicate course

I paid my fees via

Upfront Payment

Payment Plan

Please indicate reason for cancellation

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 14 day cooling off period

Yes

No

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

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