Student Course Deferment Application Form - Lifetime International Training College
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1Lifetime International Training College
Suite 30505, Tower 3, Level 5, 9 Lawson Street, Southport Qld 4215
Brisbane: 478 Logan Road, Greenslopes QLD 4120
Tel | Fax: +61 7 5528 5382Tel | Fax: +61 7 3847 2080
Postal Address PO Box 125 Stone Corner QLD 4120
E:
admin@lifetime.qld.edu.au
W:
RTO: 5877
CRICOS: 02762G
ABN: 74 080 098 120
STUDENT COURSE DEFERMENT APPLICATION FORM
(Attachment 8 (a) Standard 13)
For current students needing to temporarily withdraw from their course.
Evidence must be attached before lodging application:
Student Details
Given Name: ____________________________Family Name: ______________________________________
Gender: Male □
Female □
Student ID No: LT-B____
Date of birth: _______________________ Country of birth: ____________________________
Nationality: _______________________
Passport number: _________________________
Passport expiry date: ____________________
Address in Australia
Local current address: ______________________________________________________________________
Suburb: _____________________
State: QLD Postcode: _______________
Phone number: __________________________ Email address: ____________________________________
Deferment Particulars
Course to be deferred:_______________________________________________________________________
Deferment start date: _______________________
Deferment end date:____________________________
Reason for deferment:_______________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Attach evidence:
Student signature: _________________________________ Date:_______________________
Office Use Only
Course Payment: Up to date □
Overdue □
Evidence Attached: Y □
N □
Approved: ___________________________________Disapproved:___________________________
Comments:
_________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Registrar Signature: ____________________________________ Date: _______________________
COURSE DEFERMENT FORM - Version 1–01.02.2017
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