CHANGE OF ENROLMENT, WITHDRAWAL AND REFUND FORM

CHANGE OF ENROLMENT, WITHDRAWAL AND REFUND FORM
Ākonga (Student) Details
Name

First NameLast Name
Student ID Number
Date of Birth

DayMonthYear
Date
Withdrawal from ProgrammeWithdrawal from CourseTransfer to another Programme
Withdrawal from Programme
Withdrawal from Course/s
(please list all courses withdrawing from)
Transfer to Programme
(transfers must be within the same year - if you are unsure, please discuss with your School or email info@witt.ac.nz)
Reasons for leaving the programme
Comments
Bank Account Number
(if applicable)
Proof of Bank details

(please provide bank statement header including bank logo, address and account number)
Cancelof
If you are withdrawing from the entire programme and applying for a refund understand that:
- If your fees are not yet paid you may be responsible for the outstanding amount
- If you have completed any NZQCF Standards you will be responsible for paying the fee associated with Standards
- Withdrawing/changing your course or programme may have implications for EFTS, allowances and loans and it is your responsibility to check this
- Any refund is calculated according to the Domestic & International Student Withdrawal, Transfers and Refund Policy. Refunds will only be considered on receipt of this completed form.
- This form will only be actioned if signed by the student and the Director of School or delegate.
- Refunds will be processed on the 20th of the following month
Student Signature
By signing this form electronically, I understand it is legally binding and represents my official request to withdraw from this course.
Date

DayMonthYear
Date
OFFICE USE ONLY:
WITT INITIATED WITHDRAWAL
Has ākonga indicated that they do not intend to continue?

YesNo
Has the ākonga been contcted and given notice of WITT's intention to withdraw due to insufficient progress?

YesNo
Non-Contact/Never attended

YesNo
Insert Comments on Attendance or Interview
Is this WD Prior to 80% of the programme of delivery?

YesNo
Has ākonga successfully completed any NZQCF Standards?

YesNo
Unit Standards achieved
Fees to be retained amount
Comments
Received by:
International Team (if applicable):

First NameLast Name
Date

MonthDayYear
Date
Authorised by Director of School or delegate:

First NameLast Name
Date

MonthDayYear
Date
Processed by:

First NameLast Name
Date

MonthDayYear
Date
REFUND

Refer to Domestic and International Ākonga Withdrawal, Transfers and Refund Policy for refund conditions.
Tuition fee paid
Fees retained
Total Refund
Approved by:

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

CHANGE OF ENROLMENT, WITHDRAWAL AND REFUND FORM

Ākonga (Student) Details

OFFICE USE ONLY:

WITT INITIATED WITHDRAWAL

Received by:

REFUND