Higher Education Application for Refund Withdrawal

Higher Education Application for Deferment & Leave of Absence

This form is for use by local students only. International students refer to TAFE International Western Australia’s refund policy. This can be located on the TIWA website:

STUDENT DETAILS

Surname/Family name / Given name/s
Postal address / Student ID. Number
Email / Mobile number
Have your tuition fees in relation to this application been paid by:
FEE-HELP
Paid up-front
Fess payment plan

I wish to apply for (Please tick appropriate box)

Deferral until a later date(Complete section A and E)

Deferral will only be for a maximum of 2 semesters.

Leave of Absence (Complete section A, B,Cand E)

Leave of Absence is for short term discontinuation of studies only due to compelling/ compassionate circumstance. You should be able to continue studies in the semester and progress successfully.

Section A. COURSE & UNIT DETAILS (please specify the course and the units which this application applies to)

Course Title / Course Code
Unit Code / Unit Title / Semester / Year

Section B. REASONS FOR LEAVE FROM STUDIES

Please indicate below the main reason you are deferring
□Sickness (with supporting medical evidence)
□Bereavement (with supporting evidence)
□General leave (reason to be supplied and approved)
□Other. Evidence and approval required.
(*Deferral will be for a maximum of 2 semesters)

Section C. SPECIAL CIRCUMSTANCES * Documentary proof required

Please summarise the special circumstances that have impacted on your ability to complete the units listed above:

What are ‘special circumstances?’

The special circumstances for a Leave of Absence to be granted would need to meet the two following conditions:

1.The circumstances were beyond your control.

Circumstances are beyond your control if a situation occurs which a reasonable person would consider is not due to your action or inaction, either direct or indirect, and for which you are not responsible. This situation must be unusual, uncommon or abnormal.

2.The circumstances have made it impracticable for you to temporarily continue to study

Circumstances that make it impracticable for you to temporarilycontinue to study include:

-Medical circumstances. For example, where your medical condition has changed to such an extent that you are temporarilyunable to continue studying;

-Family/personal circumstances. For example, death or severe medical problems within a family, or unforeseen family financial difficulties, so that it is unreasonable to expect you to temporarilycontinue your studies;

-Employment-related circumstances. For example, where your employment status or arrangements have changed so that you are temporarilyunable to continue your studies, and this change is beyond your control.

Documentation Required

You must attach independent supporting documentation (original or certified copies) from a relevant authority (eg. doctor, counsellor, employer) to your application. “Independent” means it should not be from your family or friends. Privacy laws preclude us from obtaining information on your behalf so you are responsible for providing evidence to support your claim. It is not sufficient to provide only a personal statement outlining your special circumstances.

Supporting documentation should include for medical reasons a statement from your doctor, for family reasons a statement from a doctor, councillor or independent member of the community (e.g Justice of the Peace) indicating:

-The date your medical condition/personal circumstances began or changed;

-How your condition affected your ability to study; and,

-When it became apparent that you could not continue with your studies.

For employment-related reasons a statement from your employer indicating:

-Your previous work hours and location;

-Your current work hours and location; and,

-The reason for changed hours and location.

Supplementary documentation may also be included. Your documents must be originals or certified copies.

Applications

Application formsare available from your Course Coordinator or online. Supporting documentation must be included and lodged according to the instructions on the form.

Applications and independent supporting documents must be submitted to your Course Coordinator

Note: The Institute is bound by law to protect your privacy therefore any information you provide in relation to this application will only be used for the purpose intended, including notification to the relevant Government Agencies.

Decisions

You will be advised in writing of the outcome of your application within 10 working days of the Collegereceiving your application. If your application is unsuccessful the College will provide you with information about requesting a review of the decision. This must be done in writing within 28 days of receiving the original decision.

Section E: STUDENT DECLARATION

I declare that the information supplied on this form and the information given in support of my application is correct and complete. I acknowledge that the provision of incorrect or misleading information or the withholding of relevant information relating to my application may result in a delay in processing or result in a decision based on the information already provided.
Student signature: / Date:

CHECKLIST:

Before submitting your application, please check that:
you have carefully read and understood the attached instructions and believe your situation meets the criteria for special consideration;;
you have attached original independent supporting documentation to support your claim that your condition changed to the extent that you could not continue your studies; and,
you have completed all relevant sections of this application.

OFFICE USE ONLY

Course Coordinator/HoP received on:
(Date) / ReceivedBy:
Name
Position
Signature
Reviewed by: / Outcome: / Student file edited:
Delivery unit contacted on: / Action taken:

__  ______ ______ __ __ _

Please detach this section and return to the student

Receipt of the Higher Education Application for Deferment & Leave of Absence Form

Student Name
Course Coordinator/HoP received on:
(Date) / Received by:
Name
Position
Signature