Request Form - Release to Another Provider

Student Full Name*

Student ID *

Date of Birth

Student Email Address*

Student Contact Number*

Current Address*

Street Address

SuburbState

PostalCountry

Have you completed six months of your Principal Course? The Principal Course of study refers to the main course of study to be undertaken where a student visa has been issued for multiple courses of study (E.g. If you enrol for the package of Certificate IV and Diploma, your Principal Course is Diploma)*

YESNO

Name of another provider that you are transferring to*

Name of new course(s)*

A statement of reasons for this transfer request*

Letter of Offer from another provider and any other supporting documents*

Declaration*

I declare that the information provided by me on this form is true and correct.I understand that providing false or misleading information or fraudulent documents is considered as student misbehavior and could put myself at the risk of being suspended from the course or being reported to Department of Education and Department of Home Affairs.I agree and give my permission to Evolution to release of personal information for the purpose of resolving this request.I understand that the request has to follow the related policies and procedures.I understand that the request can take up to 10 business days to process.I understand that if I am an international student, I must remain financial and enrolled in a registered course and satisfactory attendance in my course and course progress for each study period as required.

Signature*

Date*

Officer Name*

First NameLast Name

Decision

APPROVEDECLINE

Comment(s)*

Signature*

Date*