Course Withdrawal or Leave of Absence Form

Course 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

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 Psychotherapy Graduate Diploma of Counselling and Psychotherapy Master of Counselling and Psychotherapy Graduate Diploma of Psychological Science (2+3) Bachelor 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:

Withdrawal from Course (all units will be cancelled and you will need to reapply if you wish to study again)

Withdrawal from Specific Units

Leave of Absence (LOA)

Deferral

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 upload 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 upload size: 2.1MB

Date requested: *

Confirmation *

Check this box to digitally sign and confirm that you are the student named in this submission. Applications made after the census date will incur full tuition costs for all relevant subjects.

Submit

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