Deferment Suspension Cancellation (DSC) Form
Section 1 - Client Details
Student ID
*
GLEXXXXXX
Name:
*
Contact Tel:
Mobile:
*
Email:
*
example@example.com
Course Currently Enrolled:
*
Please Select
ELICOS - General English Program
BSB50420 - Diploma of Leadership and Management
BSB60420 - Advanced Diploma of Leadership and Management
BSB80120 - Graduate Diploma of Management (Learning)
ICT50220 - Diploma of Information Technology
ICT60220 - Advanced Diploma of Information Technology
SIT30821 - Certificate III in Commercial Cookery
SIT40521 - Certificate IV in Kitchen Management
SIT50416 - Diploma of Hospitality Management
SIT60316 - Advanced Diploma of Hospitality Management
AUR30620 - Certificate III in Light Vehicle Mechanical Technology
AUR40226 - Certificate IV in Automotive Mechanical Diagnosis
AUR50126 - Diploma of Automotive Management
CPC30220 - Certificate III in Carpentry
CPC50220 - Diploma of Building & Construction
RII60520 - Advanced Diploma of Civil Construction Design
CPC31220 - Certificate III in Wall and Ceiling Lining
CPC33020 - Certificate III in Bricklaying and Blocklaying
CPC31320 - Certificate III in Wall and Floor Tiling
CPC40120 - Certificate IV in Building and Construction (Building)
Course Start date:
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Course End date:
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
List Other courses, if in case you are applying for Cancellation/Withdrawal
(Otherwise, leave blank)
Course Currently Enrolled:
Please Select
ELICOS - General English Program
BSB50420 - Diploma of Leadership and Management
BSB60420 - Advanced Diploma of Leadership and Management
BSB80120 - Graduate Diploma of Management (Learning)
ICT50220 - Diploma of Information Technology
ICT60220 - Advanced Diploma of Information Technology
SIT30821 - Certificate III in Commercial Cookery
SIT40521 - Certificate IV in Kitchen Management
SIT50416 - Diploma of Hospitality Management
SIT60316 - Advanced Diploma of Hospitality Management
AUR30620 - Certificate III in Light Vehicle Mechanical Technology
AUR40226 - Certificate IV in Automotive Mechanical Diagnosis
AUR50126 - Diploma of Automotive Management
CPC30220 - Certificate III in Carpentry
CPC50220 - Diploma of Building & Construction
RII60520 - Advanced Diploma of Civil Construction Design
Course Currently Enrolled:
Please Select
ELICOS - General English Program
BSB50420 - Diploma of Leadership and Management
BSB60420 - Advanced Diploma of Leadership and Management
BSB80120 - Graduate Diploma of Management (Learning)
ICT50220 - Diploma of Information Technology
ICT60220 - Advanced Diploma of Information Technology
SIT30821 - Certificate III in Commercial Cookery
SIT40521 - Certificate IV in Kitchen Management
SIT50416 - Diploma of Hospitality Management
SIT60316 - Advanced Diploma of Hospitality Management
AUR30620 - Certificate III in Light Vehicle Mechanical Technology
AUR40226 - Certificate IV in Automotive Mechanical Diagnosis
AUR50126 - Diploma of Automotive Management
CPC30220 - Certificate III in Carpentry
CPC50220 - Diploma of Building & Construction
RII60520 - Advanced Diploma of Civil Construction Design
Course Currently Enrolled:
Please Select
ELICOS - General English Program
BSB50420 - Diploma of Leadership and Management
BSB60420 - Advanced Diploma of Leadership and Management
BSB80120 - Graduate Diploma of Management (Learning)
ICT50220 - Diploma of Information Technology
ICT60220 - Advanced Diploma of Information Technology
SIT30821 - Certificate III in Commercial Cookery
SIT40521 - Certificate IV in Kitchen Management
SIT50416 - Diploma of Hospitality Management
SIT60316 - Advanced Diploma of Hospitality Management
AUR30620 - Certificate III in Light Vehicle Mechanical Technology
AUR40226 - Certificate IV in Automotive Mechanical Diagnosis
AUR50126 - Diploma of Automotive Management
CPC30220 - Certificate III in Carpentry
CPC50220 - Diploma of Building & Construction
RII60520 - Advanced Diploma of Civil Construction Design
Section 2
Please select your reason for your application
*
Deferment
Suspension
Cancellation
Reason for cancellation:
*
Date effective from:
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Till: (if applicable)
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Section 3
Evidence Provided
*
A letter from a registered Medical Practitioner due Sickness.
Evidence for the family emergency, if cited as a family reason.
Appropriate evidence for compassionate grounds
If traveling overseas, attach a copy of travel tickets
Other
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Section 4 – Reasons
Reason:
*
Student Declaration
I understand that:
*
The application will be considered in accordance with Glen Institute’s Deferral Suspension Cancellation Withdrawal Policy.
I understand and acknowledge that my request will take up to 30 calendar days.
My deferral will be subject to course availability.
I understand the implications of my student visa
I have attached all required supporting documentation
I will notify Glen Institute in writing if my circumstances change
If the matter pertains to Deferment / Suspension, this will be reported to Department of Home affairs as per Government Policy. This can affect a student’s visa and I am aware that under such circumstances, I need to contact Department of Home affairs on 131881 if I need more information on this.
My Fee payment is up to date.
Signing this form does not mean that it is approved, you need to wait for Glen Institute's approval communication.
Signature
*
Date
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Finance Approval
Request approved by finance
Yes
No
N/A
Date
Date
Print Name:
Signature
Signature
Section 4 - Authorisation
Requested Change has been approved:
Yes
No
If No, provide reason below:
Signature
*
Position
Print Name:
Date Processed:
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Admin Use Only
Changed in Accounts
Yes
No
N/A
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Staff Initials
Changed in SMS:
Yes
No
N/A
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Staff Initials
Changed in PRISMS:
Yes
No
N/A
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Staff Initials
Formal Letter/Email Sent:
Yes
No
N/A
Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Staff Initials
Sent by:
Signature
Submit
Should be Empty: