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 (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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