Application for Leave/Deferment/Suspension

Full Names :

Student Id :

Contact number :

Address

Leave Type: (please tick appropriate box)

Holiday Leave Sick Leave Deferment Leave (please specify reason for deferment: ) Suspension Leave (please specify reason for suspension: )

Please elaborate on your reason for Leave request:

Please specify the date in which you request to begin and conclude leave

Start Date:

End Date:

Length (in days):

Please provide the following in support of your leave request

Return ticket
Evidence

Filled Application Form

Are you travelling outside Australia?

Yes No

Person of Contact

Within Australia:

Name:

Phone Number:

Relationship:

Overseas:

Name:

Phone Number:

Relationship:

Declaration

I hereby understand that as part of the Letter of Offer and Student Agreement, Refund Policy, that it is solely my responsibility to maintain course progress and uphold my Payment Plan payments whilst on leave.

I understand that this suspension or deferment or leave of absence will be reported via PRISMS and may affect my student visa.

Applicant’s Signature : your image

Date :

Office Use Only

Authorisation by the Program Director

I hereby authorise for _________________________________________(name) to ____________days leave/deferment.

_________________________________        __________________
Program Director Signature                                 Date

Authorisation by the Program Director

_________________________________        __________________
President’s Signature                                                   Date