WITHDRAW APPLICATION FORM

WITHDRAW APPLICATION FORM
This form is to be used when making an application to discontinue with your studies. If you are withdrawing before you have completed six months of your principal course of study, you must instead complete the Release Application Form.

Please note that any refunds will be processed as per the information included in the International Student Handbook about fees and refunds. If you believe you are due a refund you should also complete the Refund Application Form.
1. STUDENT DETAILS
Given Name/s
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Date

MonthDayYear
Date
Gender
Gender

MaleFemaleOther
Nationality*
Student Number*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Email Address*
example@example.com
2. REASON FOR WITHDRAWAL
Reason for Withdrawal*
Please briefly describe the reason you have decided to discontinue your studies.
Effective Date

MonthDayYear
Please specify the date from which you would like this withdrawal notice to take effect.
Supporting Document/s for the withdrawal application

(e.g. medical report, flight details, or any other relevant documents)
Cancelof
Upload the payment receipt for the fees (if applicable)

Cancelof
3. Refund Request Section
Refund Required

YesNo
3. DECLARATION
Acknowledgment

I declare that the information provided is accurate and complete. I have read and understood the Deferral, Suspension, and Cancellation Policy and acknowledge that my request will be processed according to the guidelines stated therein.
Student's Signature*

Clear
Date*

MonthDayYear
Date today
Submission Instructions:
1. Fill out all fields completely. Incomplete applications may delay processing.
2. Submit this form online or to the Student Services Office in person or via email to enrolments@rosehillcollege.edu.au.
3. Review Period: Allow up to 10 business days for a response.
4. Refund Process: If a refund is required, ensure the Refund Application Form is completed and submitted.

Office Use Only
Outcome

ApprovedNot Approved
Comments/Reasons
Approval by:
Position
Signature

Clear
Date

MonthDayYear
Date
Compliance Checklist Section
Criteria Met

YesNo
Documentation Complete

YesNo
Data Secured

YesNo
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COMPLAINTS AND APPEALS FORM V1.0
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Should be Empty:

WITHDRAW APPLICATION FORM

1. STUDENT DETAILS

2. REASON FOR WITHDRAWAL

3. Refund Request Section

3. DECLARATION

Compliance Checklist Section