Special Consideration Form

Request

Select the option that best describes your request.

I want to take a leave of absence from my course*

I want to cancel or withdraw from my course*

I want to defer my course*#

I want a release letter from QAT#

I want a study proof letter#

I want a 485 letter from QAT#

Other (Please specify below)#

* Supporting documentary evidence MUST be attached (SV holders only)

# Admin free of $50, and additional course fees may apply.

Other

Details

Date

Visa Type (if applicable)

Student Number

Mobile Number

Email(Required)

Name

Given Name Family Name

Current Address

Street Address City State / Province / Region ZIP / Postal Code Country

Course and Class

Course Class

Course Duration

From To

Message

To the Director

Student Signature

Please upload supporting documents

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

ONLY FOR REQEST OPTION A

If student is applying for leave, what units will be missed. Please outline below.

Intervention Notes / Catchup Agreement

Consent

I understand

Failure to adhere to the terms of this strategy may lead to further action being taken by the college. I understand that if I am applying for leave and this request if not approved I will be required to pay late submission fees ($50.00) for each unit.

Trainers Signature

Co-ordinators Signature

Students Signature

Date

Received by

Special Consideration Form

Request

Details

Message

ONLY FOR REQEST OPTION A

OUR COURSES

FOR STUDENTS

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