Higher Education Application for Refund Withdrawal

Higher Education Application for Refund Withdrawal QD500101 This form is for use by local students only. International students refer to Education and Training International’s refund policy. This can be located on the TIWA website: https://www.tafeinternational.wa.edu.au/

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 Scholarship

I wish to apply for (Please tick appropriate box) Withdrawal prior to Administration Date (Complete section A, B & E) There is no fee for withdrawal prior to Administration Date. Your FEE-HELP debt in relation to this application will be cancelled or tuition fees refunded.

Withdrawal prior to Census Date (Complete section A, B & E) If you withdraw from units after the Administration Date but prior to the Census Date you will incur an administration fee unless you qualify for special circumstances (refer to section D). The administration fee is $50 per unit. Your FEE-HELP debt in relation to this application will be cancelled however you will receive an invoice for the administration fee.

Withdrawal after Census Date under Special Circumstances (including application for refund of fees or remission of FEE-HELP Debt) (Complete section A, B, D & E) If you withdraw from units or discontinue your course after the census (financial penalty) date you remain liable for the cost of those units. However, if you can demonstrate special circumstances, you may be eligible for: - A refund of your Student Contribution Amount if you have paid upfront; - Remission of re-credit of FEE-HELP debts; - A refund of any up-front Tuition Fees paid; - Withdrawal without academic penalty (only applicable if you withdraw after the census date and before the academic penalty date).

RTO Provider No. 52787 TAFE International WA Provider No. 52395 – CRICOS Code 00020G Issue date: 23/06/2017 Review date: 23/06/2017 Use with: QD50 1Uncontrolled when printed. The current version of this document is available on QMS

Withdrawal after Census Date without academic penalty, no Special Circumstances. (Complete section A, B & E) This is for application for withdrawal after Census Date but prior to the Academic Penalty date

Deferral until a later date (Complete section A, C & E) Deferral will only be for a maximum of 1 semester.

Census is no less than 20% of the semester which is typically the last day of week 4. Refer to the Higher Education Academic Calendar for the Administration Date, Census Date and Academic Penalty Date. Note: You cannot apply for a re-credit or a remission if you have successfully completed the unit of study.

Section A. COURSE & UNIT DETAILS (please specify the course and the units which this application applies to) Course Course Title Code Unit Code Unit Title Semester Year

Section B. REASONS FOR WITHDRAWAL Please indicate below the main reason you are withdrawing □ Transfer to another institution, if so which institute are you transferring to?

□ Transfer to another South Metropolitan TAFE Higher Education course □ Transfer to another South Metropolitan TAFE vocational course. If you are transferring to another South Metropolitan TAFE course please provide course name.

□ Gained employment

□ Personal/Family reasons (including medical/travel etc) □ Financial reasons □ Difficulty maintaining academic progress □ English language difficulty □ Course not meeting expectations/requirements □ Travel distance to South Metropolitan TAFE campus □ Other, please state

Section C. REASONS FOR DEFERRAL 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 only be for a maximum of 1 semester)

Section D. SPECIAL CIRCUMSTANCES

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

What are ‘special circumstances?’ In accordance with the guidelines issued by the Federal Government, to receive a remission of debt, the special circumstances would need to meet all three of the 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 made their full impact on you, on or after the census date.

3. The circumstances have made it impracticable for you to complete the requirements for a unit of study. Circumstances that make it impracticable for you to complete the requirements for you unit(s) of study include: - Medical circumstances. For example, where your medical condition has changed to such an extent that you are unable 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 continue your studies; - Employment-related circumstances. For example, where your employment status or arrangements have changed so that you are unable to continue your studies, and this change is beyond your control. You may be considered unable to complete the requirements for a unit, for example, if you are unable to: - undertake the necessary private study required; or - attend sufficient lectures or tutorials; or - meet compulsory attendance requirements in order to meet your compulsory course requirements; or - complete the required assessable work; or - sit the required examinations; or - complete any other course requirements because of your inability to meet the above.

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 forms are available from Higher Education Directorate or online and must be lodged within 12 months of the unit discontinuation date. If you failed the unit but did not formally discontinue you must lodge your application within 12 months of the last day of the semester in which you were enrolled in the unit.

Applications received after this period cannot be considered. Supporting documentation must be included and lodged according to the instructions on the form. Applications and independent supporting documents must be submitted to: Higher Education Directorate, Bentley Campus. 1 Fleet St Fremantle WA 6160 [email protected]

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 20 working days of the Institute receiving your application. If your application is unsuccessful the Institute 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 are submitting the application within the time frame stipulated; 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 sections of this application.

OFFICE USE ONLY Higher Education Student By: Services received on:

Reviewed by: Outcome: Student CRM file edited:

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