Application For Release Letter - The Imperial College Of Australia
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1The Imperial College of Australia
A.B.N. 85 123 406 039
212 Hoddle St, Abbotsford Victoria 3067, Australia
Postal Address: PO Box 375, Abbotsford Victoria 3067, Australia
Tel 61 3 9417 4777, Fax 61 3 9417 4787
Web
Email
info@imperial.edu.au
Application for Release Letter
Personal Details
Student Number:
Date of Birth:
/
/
Title:
Family Name:
Given Name:
Current Mailing Address:
Telephone (Day):
After Hours:
Email:
Course Information
Course Code:
Course Name (e.g. Diploma of Business):
Course Commencement Date:
NOTE: An essential condition for a letter of release to be granted is that the student has a letter
from another registered provider confirming that a valid enrolment offer has been made. A copy of
the enrolment offer letter must be attached to this application form.
Reason(s) for Withdrawal from Course
You must provide information on your reason(s) for requesting the release letter from the course,
specifically how your circumstances:
changed on or after the course start date;
prevented you from completing your studies; and
any other reason
______________________________________________________________________________
______________________________________________________________________________
Student’s Signature____________________________ Date for requested Release____________
OFFICE USE ONLY
Approved By
√ or X
Signature
Date
Accounts Department - Outstanding fees $_______
Coordinator
Senior General Manager
Application’s Assessor _________________________________________ Date ______________
Outcome:
Approved:
Rejected:
Comments______________________________________________________________________
BJSB Pty Ltd trading as
Application for Release Letter
The Imperial College of Australia
Version: March 2015
CRICOS ID: 02858M RTO ID: 121966
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