Letter Of Release /COE Cancellation Request Application Form

Student ID(Required)

Given Name(Required)

Surname(Required)

Telephone No(Required)

Email Address(Required)

Current Address(Required)

Course(Required)

Major

Please provide details of your request(Required)

Provide details of the course and institution (education provider) to whom you intend to transfer

Course Name(Required)

Institution Name(Required)

Commencement Date(Required)

Institution Address(Required)

Where applicable, attach / submit the following to / along with your request:

Copy of a valid Offer of Enrolment Letter from institution you wish to transfer into(Required)

Max. file size: 128 MB.

Other evidence supporting your request.

Drop files here or

Max. file size: 128 MB.

Student Signature

Date

If it is for the office use

Received By Name

Signature

Date

Reviewed By Name

Signature

Date

Decision

Student Support Manager

Date

Dean (or nominee) Signature

Date