Form

Please fill out your personal details here.

First name*

Last name*

Mobile phone number*

Date of Birth*

Year/Month/Day

Email*

Student ID Number:*

I am...*

Street address*

City*

Postal Code*

State/Region*

Country*

Course Name

Start Date*

Year/Month/Day

Study Location*

Please outline the reasons/circumstances for seeking deferral/ suspension:

Comments*

Deferral/Suspension start date*

Year/Month/Day

Deferral/Suspension finish date:*

Year/Month/Day

Duration of deferral or suspension (weeks):

Before submitting this application you must provide sufficient evidence for compelling or compassionate circumstances that support my request. Click here to upload any evidence you may have.*

This can include medical certificates, or other relevant evidence supporting your request.

Declaration*

I confirm the above information is true and correct