Lead:Smart & Skilled - course withdrawal form

Course Withdrawal Form

Lead-Smart & Skilled
SECTION A: CURRENT PERSONAL DETAILS
Student ID*
Student Full Name*

PrefixFirst NameMiddle NameLast Name
Mobile Number*
Email*
Date of Birth*

MonthDayYear
Date
Gender*

FemaleMale
SECTION B: DETAILS OF CURRENT ENROLMENT
Course Code*
Course Title*
Date Commenced*

MonthDayYear
Date
Campus*
Withdrawal date: I wish to withdrawal from my course effective from (Please specific date:*

MonthDayYear
Date
Reason For Course Withdrawal (Please tick on of the following options or outline the circumstances/reasons) :*

MedicalEmploymentTransfer to another Lead College CourseFamilyPersonalCourse not suitableDissatisfaction with course/teachingOther
Do you have evidence to support the circumstances / reasons outlined above? (If "YES" , ensure that you provide the supporting documentation.)

YesNo
Supporting Documentation

Browse Files

Cancelof
SECTION C: DECLARATION AND SIGNATURE

I understand that the information I have provided is true and correct. This is a request for withdrawal from the course and my current enrolment will be cancelled. If applicable, my entiltlement to a refund will be assessed in accordance with Lead College refund’s policy.
I DECARE THAT:
Please tick the boxes above, sign the form below and return to either Reception or the Sudent Support Officer at Lead College.
Student Signature*

Clear
Printed Name
Date

DayMonthYear
Date
Should be Empty:

Course Withdrawal Form