Enrolment Withdrawal Form

Full Name

Date of Birth

Address

USI Number

Email

Phone

Withdrawal Date

Please indicate course

Please indicate reason for cancellation Please indicate reason for cancellation

Are you currently doing your Work placement?

Yes

No

If you are currently doing your placement you have to stop working from deferral start date.

Any Work placement or supervision provided during your deferral time will not be validated for your assessment.

I am

Within my 14 day cooling off period

Not on 14 day cooling off period

I paid my fees via

Upfront Payment

Payment Plan

Declaration - Withdrawal

I wish to withdraw from the above course effective from today

Declaration - Correct

I confirm the information above and acknowledge that the above information is true

Declaration - Payment Plan

I acknowledge I am required to pay an additional $200 to cancel my payment plan as per ACOBA policies – Terms and Conditions of Enrolment.

Declaration - Refund Policy

I acknowledge that I am not entitled to a refund of fees in accordance with the refund policy.

Payment Method for cancellation fees

Upfront Payment

Payment Plan