Student name
Student ID
Date [datetime datetime-619 id:r-date date-format:mm/dd/yy time-format:HH:mm]
Course Enrolled In
Email Address
Contact No

Please tick the applicable box to indicate your amendment type:

DEFER EnrolmentSUSPEND EnrolmentCANCEL EnrolmentWITHDRAW Enrolment

Please give a brief explanation of your reasons for amending your enrolment to support your application:

I am aware of the consequences of deferring, suspending, cancelling or withdrawing my enrolment.
I am also aware that the decision to grant my deferral, suspension, or cancellation of enrolment may affect my student visa (international students only).

Student name
Student Sign
Date[datetime datetime-533 id:rr-cf-sdate date-format:mm/dd/yy time-format:HH:mm]