Application for Deferral/Suspension Form

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Contact Details During Deferral/Suspension Period
Future (Temporary) Residential Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Which Course you are studying?
Term
Attending Days

e.g.Monday
Mobile Number*
Email Address*
Preferred Contact Method*
- Select All
- Phone
- Email
- Letter

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Request
Request*
Please tick one of the following
- Deferral of the Course Enrolment
- Suspension of Study temporarily
- Withdrawal from the Course
Details of Student’s Visa
Visa Subclass*
Visa Issue Date*
Date Format: DD slash MM slash YYYY
Visa Expiry Date*
Date Format: DD slash MM slash YYYY
Applied for visa extension*
- No
- Yes
Details of Request
Please provide details of your request in the space below
The student must submit documentary evidence on why he needs this deferral/suspension.
Student’s Signature*
Date*
Date Format: DD slash MM slash YYYY

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Personal Details