Enrolment Withdrawal Form Full Name * Date of Birth * Address * USI Number * Email * Phone * Withdrawal Date * Please indicate course * -- Please select --CHC33015 Certificate III in Individual SupportCHC33021 Certificate III in Individual SupportCHC40313 Certificate IV in Child, Youth and Family InterventionCHC40321 Certificate IV in Child, Youth and Family InterventionCHC40413 Certificate IV in Youth WorkCHC40421 Certificate IV in Youth WorkCHC43015 Certificate IV in Ageing SupportCHC43015 Certificate IV in Ageing SupportCHC43115 Certificate IV in DisabilityCHC43121 Certificate IV in DisabilityCHC43215 Certificate IV in Alcohol and Other DrugsCHC43315 Certificate IV in Mental HealthCHC50313 Diploma of Child, Youth and Family InterventionCHC50321 Diploma of Child, Youth and Family InterventionCHC50413 Diploma of Youth WorkCHC50421 Diploma of Youth WorkCHC51015 Diploma of CounsellingCHC52015 Diploma of Community ServicesCHC52021 Diploma of Community ServicesCHC53215 Diploma of Alcohol and Other DrugsCHC53315 Diploma of Mental HealthCPSC001 Child Protection Short CourseCPSC002 Child Trauma Care and Protection Short CourseHLT33015 Certificate III in Allied Health AssistanceHLT33021 Certificate III in Allied Health AssistanceHLT43015 Certificate IV in Allied Health AssistanceHLT43021 Certificate IV in Allied Health AssistanceCHC30121 Certificate III in Early Childhood Education and CareCHC30221 Certificate III in School Based Education SupportCHC40221 Certificate IV in School Based Education SupportCHC50221 Diploma of School Age Education and CareBSB30120 Certificate III in BusinessSIS30321 Certificate III in FitnessSIS40221 Certificate IV in FitnessDual Qualification in FitnessSkill Set: CHCSS00137 Palliative ApproachResidential and Out of Home Care Short CourseSkill Set: CHCSS00133 Induction to Disability SupportCHCSS00141 Child Protection Skill Set I paid my fees via * Upfront Payment Payment Plan Please indicate reason for cancellation -- Please select --Non ActivityCareer ChangePersonal / Medical ReasonsPerformance IssueLoss of InterestOther 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 cooling off period Outside my cooling off period Your cooling off period is 7 days from your enrolment date. I will pay cancelation fees via Upfront Payment Payment Plan Student Declaration: I acknowledge I have read the withdrawal and refund policy * Agree I acknowledge my withdrawal will be effective from the date selected * Agree I confirm the information provided is correct * Agree Submit
