Withdrawal Application Form

Withdrawal Application Form

Use this form to request withdrawal from your studies at Rosehill College. If you are withdrawing before completing six months of your principal course, you must complete the Release Application Form instead. Review the Deferral, Suspension, and Cancellation Policy on our website and the Student Handbook before completing this form.
1. Student Information Section
Full Name*
Date of Birth

MonthDayYear
Date
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. Withdrawal Request Section
Reason for Withdrawal
Effective Date

MonthDayYear
Date
3. Refund Request Section
Refund Required

YesNo
Complete Refund Form:
If Yes, please complete the Refund Application Form separately.
4. Student Declaration Section
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
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
Should be Empty:

Withdrawal Application Form

1. Student Information Section

2. Withdrawal Request Section

3. Refund Request Section

4. Student Declaration Section

Compliance Checklist Section