Program Withdrawal &/or Refund Request Form

This form is for:

• Program Withdrawal only
• Program Withdrawal and Refund
• Refund only

Students who wish to withdraw completely from their program of study and do not intend to continue studying any other programs in Newcastle Australia Institute of Higher Education (Newcastle Australia) are required to complete this form and refer to the 'Refund, Course Transfer, Leave of Absence and Withdrawal Policies' found on Newcastle Australia's website for more detailed information.

I, {fullName}, (UON Student ID: {uonStudent}),

• confirm my decision to withdraw from the program of study
• have read and understood the Withdrawal and Refund Policy found on Newcastle Australia's website
• hereby indemnify Newcastle Australia against all claims with respect to this withdrawal and declare that all information provided here are accurate and true.

• confirm my decision to withdraw from the program of study
• would like to request a refund of the program Tuition Fees, in accordance to the Refund Policy, where applicable.
• understand that there is no refund of Miscellaneous Fees listed under Schedule C of the Student Contract.
• have read and understood the Withdrawal and Refund Policy found on Newcastle Australia's website and agree to have any refund of the program Tuition Fees if applicable.
• agree that I shall be responsible for any incurrence of additional charges if the information provided by me is insufficient and/or wrong, which will result in a delay of the refund payment.
• hereby indemnify Newcastle Australia against all claims with respect to this refund and declare that all information provided here are accurate and true.

• agree that I shall be responsible for any incurrence of additional charges if the information provided by me is insufficient and/or wrong, which will result in a delay of the refund payment.
• hereby indemnify Newcastle Australia against all claims with respect to this refund and declare that all information provided here are accurate and true.