Course Withdrawal or Leave of Absence Form

Withdrawal or Leave of Absence

Use this form to apply to withdraw from, defer or take a leave of absence for the whole course or withdraw from specific units. This form can also be used to indicate a request to exit early from a current course with a lower level qualification.

Important: Withdrawal or leave applied for after the relevant census date for any unit enrolments will incur full costs and a LWD fail result for those units.

Personal Details

Given Name *

Family Name *

Student ID *

Contact Email *

Course * Graduate Certificate of Counselling and PsychotherapyGraduate Diploma of Counselling and PsychotherapyMaster of Counselling and PsychotherapyGraduate Diploma of Psychological Science (2+3)Bachelor of Psychology and CounsellingBachelor of Psychology (Honours)Master of Professional Psychology (MPP)Master of Professional Psychology Practice (MPPP)Master of Psychology (Clinical Psychology)Doctor of Psychology (Clinical Psychology)Post Registration (Clinical Psychology)Other Course

Application for:

Withdraw from Course

Withdraw from Unit/s

Leave of Absence (LOA)

Deferral

Are you requesting to withdraw from your current course with a lower level qualification instead? *

Yes

No

If yes, what is the award you are requesting to exit early with?If yes, what is the award you are requesting to exit early with?

Reason for withdrawal *

Unit codes

Unit Code 1: *

Unit Code 2:

Unit Code 3:

Unit Code 4:

Unit Code 5:

Unit titles

Unit Title 1: *

Unit Title 2:

Unit Title 3:

Unit Title 4

Unit Title 5:

Leave of Absence (LOA)

Starting: *

Finishing: *

Situation/Evidence *

Situation/Evidence *

Drop a file here or click to upload Choose File

Maximum file size: 2.1MB

Deferral (only available prior to the start of a course)

Returning: *

Situation/Evidence *

Situation/Evidence *

Drop a file here or click to upload Choose File

Maximum file size: 2.1MB

Date requested: *

Student Identity Check *

Check this box to digitally sign and confirm that you are the student named in this submission.

Census Dates *

Check this box to confirm that you understand any applications to withdraw from units and/or a course made after the census date will incur full tuition costs for all relevant subjects.

Submit

If you are human, leave this field blank.

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