Application for Release

Personal Detail

First Name(Required)

Surname(Required)

Student No(Required)

Date of Birth:(Required)

Current Mailing Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Telephone (Day)(Required)

(After Hours)

Email Address(Required)

Course Information

Course Code(Required)

Course Name (e.g. Diploma of Business)(Required)

Course Commencement Date(Required)

NOTE: An essential condition for a release from a course to be granted is that the student has a letter from another registered provider confirming that a valid enrolment offer has been made. A copy of the enrolment offer letter must be attached to this application form.

File

Max. file size: 100 MB.

Reason(s) for Withdrawal from Course

You must provide information on your reason(s) for requesting the release from the course, specifically how your circumstances:

any other reason(Required)

Student’s Signature

Date

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