Application for Withdrawal / Leave of Absence

Course of Study *
Withdrawal details *
Units withdrawing from
 Enrolled UnitDay and TimeLecturer

Please read the information below together with the Leave of Absence Policy before completing this form.

1. You are eligible to apply for leave of absence for a maximum of 12 months.

2. If you do not wish to enrol at the end of this 12 month period, you may apply for a further 12 months by completing this form again.

3. You can apply no more than two consecutive times with a maximum absence of two years (four semesters).

4. Applications for leave of absence must be submitted prior to the census date of the first semester from    which you are taking leave

If you do not apply for leave of absence or do not re-enrol within the approved timeframe, you may not be eligible to recommence your studies. Please reade the Leave of Absence Policy for further information.  

Reason for withdrawing / leave of absence: *

I have spoken with a member of the Student Support Team about withdrawing / intermitting my studies. *
Please sign *