FORM: STD09.005 DEFERMENT, SUSPENSION OR CANCELLATION OF ENROLMENT APPLICATION FORM

DEFERMENT, SUSPENSION OR CANCELLATION OF ENROLMENT APPLICATION FORM
If you wish to defer, suspend or cancel your course, you must complete a Deferment, Suspension or Cancellation of Enrolment Application Form and submit the form to the Reception at Times Academy. A $350 application fee is payable before the application is processed by the Admin Department.
STUDENT DETAILS:
Name*

First NameFamily Name
Phone*
Email Address*
example@example.com
Student ID*
Course Enrolled:*
Refund Payment Details ($350 Application Fee)
Bank Name*
Account Name *
BSB*
Account Number*
REQUEST INFORMATION: (Please tick one of the following options below to indicate the type of enrolment status required for processing. A $350 application fee is payable before the application is processed).
I wish to:*

Defer my course (Prior to course commences)Suspend my course: (During the current enrolment)Cancel my course: (Terminate the Enrolment Permanently)
Please use an application form for release of study if you wish to withdraw from the course and transfer to another educational provider within 6 months of the principal course.
Please Provide the Dates:
To defer the course:(Prior To course commences)
From     From       To     To

To suspend the course:(During the current enrolment)
From   From         To        To
Reasons (Please tick one of the following options)*

Visa refusedMedical ReasonsOther Compassionate and/or compelling reasonsTransfer to another Educational providerOther
Attach Documentation
- Visa refusal letter issued by DHA
Attach Documentation
- Medical Certificate/s (clear indication of unfitted period of study)
- Relationship Certificate (If Patient is student’s close family member)
- Return Travel Itinerary (If student is overseas during deferment/suspension period)
Attach Documentation

Supportive Documents
Attach Documentation
- Letter of Offer from another institution
- Statement of reasons
- Other Supportive Documents
File Upload:

Cancelof
Are you planning to do 'catch up' classes to compensate the time lost during deferment or suspension? (If Yes, please see Course Coordinator to revise your study plan and a copy must be attached).*

YesNo
Are you leaving Australia? If Yes, please attach a copy of your travel itinerary to this application and complete the overseas contact details below as per DHA requirements.*

YesNo
Overseas Address
Country
Overseas Contact Number
VISA INFORMATION:

This written application must include supporting documentary evidence to be assessed and approved by authorized officers (Administration Manager, and Principal Executive Officer) including (where appropriate): Death Certificate, Marriage Certificate, Police Report, Medical Certificate, Travel Itinerary, Letter of Offer or a Statutory Declaration where evidence is unavailable.

The process of deferring, suspending or canceling an enrolment may affect your student visa. If you have any inquiries, you should visit the DHA website https://www.homeaffairs.gov.au/ or call the DHA helpline on 131 881 or contact your local DHA office for advice to prevent an unsatisfactory visa outcome.

If you return prior to the deferment or suspension stated date or expected date, you must notify Times Academy as soon as possible.
Student Declaration / Consent:

I declare that the information provided above is true and complete. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application may delay the process of my application. I am aware that the decision to grant my deferral, suspension, or cancellation of enrolment may affect my Student Visa. I authorize Times Academy to obtain official student records from any educational institution necessary to make an informed decision about the application or matters that concern enrolment. Where my application to defer, suspend or cancel my enrolment is for period more than 28 days, I may be required to return to my home country unless approved by the Department of Home Affairs (DHA). I am responsible for contacting DHA to clarify my Visa status.
Student Signature*

Clear
Date*

DayMonthYear
Finance Department Use ONLY

A $350 application fee is payable before the application is processed.
Received By:
Signature

Clear
If application is rejected, the application fee will be refunded in Australian Dollars.
If the application is approved and students are eligible for a refund, any refunds are processed within 28 days of receiving the written request via the Refund Application Form.
Refund: $350 Application fee
If the Cancellation Request is approved, is the student eligible for a refund?

YesNo
If "Yes": Total refund: blanks
Date

MonthDayYear
Date
Initial
*Standard payment accepted include debit and credit cards (Visa and MasterCard, bank transfer or cash all in AUD. 1.5% surcharge will apply to domestic credit card transactions, 2% surcharge will apply to overseas credit card transaction. Credit card payments accepted over the phone. No refund will be given after an approved deferment or suspension.
Admin Department Use ONLY
Visa refusal letterLetter of offer from other institutionPassport copyMedical certificate/sStatement of reasonsEvidence of compassionate and / compelling circumstancesReturn home flight ticketOther
Approved
Additional Information / reason:
Not Approved:
Reason
Deferral or Suspension Start Date:

MonthDayYear
Date
Deferral or Suspension End Date:

MonthDayYear
Date
Cancel Date

MonthDayYear
Date
Assessed by
Signature

Clear
Date

MonthDayYear
Date

Action Item:

	Date:	Initials:
ACADEMIC DEPARTMENT ACTION
Revise Individual Study Plan
ADMISSION ACTION
Approved form received by ADM
Revised Letter of Offer sent to student
PRISMS ACTION
CoE/s cancelled
New CoE/s issued
Student Default reported on PRISMS (offshore visa refusal only)
Outcome recorded in PRISMS (offshore visa refusal only)
RTO MANAGER ACTION
Course Status Updated
Notice of decision sent to student
Notice of release sent to student (if approved)
Finance Department has been informed of the decision

*Once sufficient documents and application fee received, for visa refusal: Three (3) working days from receipt of form by ADM. For all other cases: five (5) working days from receipt of form by ADM
Should be Empty:

DEFERMENT, SUSPENSION OR CANCELLATION OF ENROLMENT APPLICATION FORM

STUDENT DETAILS:

Finance Department Use ONLY

Admin Department Use ONLY