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I NDEPENDENT LEARNI NG CENTRE

CENTRE DTUDES I NDPENDANTES


Administration
What is your name?
I understand that the frst unit of all my current courses must be
marked before I can request this course.
I would like to withdraw from this course:
Course code
ILC Warehouse Address
Send returnable course items to the address provided on the back of this form.
You must send all returnable items (identifed with a Y on the Package Form) to ILCs
warehouse, and return this form to ILC.
You cannot request another course if you have outstanding returnable items.
You must also complete the section Withdraw From a Course and send back any returnable items.
To change your personal information and for information about methods of payment, please turn the page.
Admin_en.indd (01/07/11)
You must sign here to re-enrol in this course.
X
You must sign here to withdraw from this course.
X
Date
I would like to re-enrol in this course:
Course code
I would like to transfer from this course:
Course code
I would like to transfer to this course:
Course code
Date
Now complete the Method of Payment section on the other side.
Now complete the Method of Payment section on the other side.
What is your student number?
I would like to request this course: (Ensure that you have the prerequisite.)
Course code
Has any of your personal information changed recently?
If so, fll out the section on the back of this page.
Request Another Course
Re-enrol in a Course
Withdraw From a Course
Transfer to Another Course
Change Personal Information
I am sending the returnable items to ILCs warehouse
in a separate mailing.
There are no returnable items.
Please indicate which case applies.
This is my frst course transfer. It is less than 60 days since I enrolled and I have not
submitted any work to ILC.
This is my second course transfer. It is less than 60 days since my frst course transfer and
I have not submitted any work to ILC.
If neither of these cases applies, then your request is considered a new course request. You must
complete the Request Another Course section and include payment.
PLEASE PRINT CLEARLY IN INK. Do not use this form if you enrolled through your school or an institution.
Request Another Course
Re-enrol in a Course
Withdraw From a Course
Transfer to Another Course
P.O. Box 200, Station Q
Toronto, ON M4T 2T1
FAX: 416.484.2754
What is your active email address? (REQUIRED) Retype your active email address (REQUIRED):
Print Form
My new name
My new address
The current non-refundable administration fee is $40.00 (for students in Ontario) and $100.00 (for students temporarily outside of Ontario).
Do not enclose cash. ILC will not be responsible if the money is lost.
If your cheque cannot be processed due to insuffcient funds, you will be charged an additional $35.00.
Fee to be paid by
Card number (print clearly) Expiry date (MM/YY)
Dont forget to write your name and student number on the other side of this page.
Send this form only to the ILC:
Box 200, Station Q
Toronto, ON M4T 2T1
Fax: 416.484.2754
ILC Warehouse Address
If you are returning course material, send it to:
Returnable Course Items
ILC Warehouse
c/o RR Donnelley
1100 Thornton Road, South
Oshawa, ON L1J 7E2
City Province Postal code
My new home phone number and area code My new business phone number, extension, and area code
Apartment/Unit number
Change Personal Information (Fill in only information that has changed.)
Method of Payment
Visa MasterCard cheque money order
Name of cardholder: _____________________________________________ Signature of cardholder: X___________________________________
Total
payment
$
Important: Make your cheque or money order payable to TVO. Postdated cheques will not be accepted.