Queensland University of Technology

LI

Student Business Services

Victoria Park Road
Kelvin Grove Qld 4059
Phone 07 3138 2000
www.student.qut.edu.au
CRICOS No. 00213J ABN 83 791 724 622

1308

Application for leave of absence or course cancellation

and/or withdrawal without penalty (international)

Personal details
Course code (eg BS05)

Student number

Family name

Given name

Date of Birth (dd/mm/yyyy)

Current mailing address

Town/suburb

State

Post code

Daytime phone Mobile phone

Email

Instructions - read this before proceeding

This form is for International students who wish to apply for leave of
absence, course cancellation and/or withdrawal without academic/financial
penalty.
You are an international student if you are not a citizen of Australia or New
Zealand, or have not been granted permanent residency or a permanent
humanitarian visa in Australia at the commencement date of your course.
If you hold temporary resident status you are regarded as an international
student.

Use this form to apply for

Leave of absence
Leave of absence will only be approved for international student visa holders
under exceptional medical or compassionate (bereavement) grounds
(The National Code Standard 13.2). Leave of absence is not normally
available to commencing students see policy E/4.5 at www.mopp.qut.edu.
au/E/E_04_05.jsp. Tuition fees will not be charged if Leave of Absence is
requested and approved prior to the start of the teaching period.
There are fee and visa implications when taking a Leave of Absence,
for more information visit: www.student.qut.edu.au/fees-and-finances/
withdrawing-from-courses-and-units
Course cancellation
There are fee and visa implications for course cancellation, for more
information visit www.student.qut.edu.au/fees-and-finances/withdrawingfrom-courses-and-units
Withdrawal without academic penalty
Students who withdraw from unit(s) after 2/3 the way through the teaching
period will receive a K- Withdrawn failure. See Key Dates (Enrolment Unit
Withdrawal) for the specific teaching period dates. If you apply for withdrawal
without academic penalty only, assessment of the case will be viewed
against those dates rather than census date.

Withdrawal without financial penalty

This form is also used to apply for withdrawal without financial penalty. If
you withdraw from your studies after the census date or have not completed
the requirements of the unit(s) of study, you must demonstrate that special
circumstances exist. You can not apply for withdrawal without financial and/
or academic penalty if you have successfully completed the unit of study.
If your case is approved you will also need to submit an application for
student fee refund (SFR form) available from www.student.qut.edu.au/forms

Documentation requirements
Please complete and submit this form along with documentary evidence
supporting your request. You can lodge this form at any Student Centre
counter or mail it to the address above. When lodging the form at a Student
Centre, please bring your passport, visa and QUT ID card. If you are mailing
the form to QUT, please attach certified copies of your visa and passport
and ensure that all other documentation provided is either the original or a
certified copy.
Supporting evidence includes documentation such as medical certificates or
statements from employers. It is your responsibility to ensure that all relevant
documentation is either an original or a certified copy. For more information
visit www.student.qut.edu.au/studying/special-circumstances

Time limits for applying

Withdrawal without financial and/or academic penalty
Your application must reach Student Business Services within 12 months
from the last day of the teaching period in which you were enrolled in the
unit(s).
These arrangements apply to all teaching periods at QUT. QUT may
consider applications made beyond 12 months if you can provide proof that
there were special circumstances which prevented you from applying until
the date of your application. A lack of knowledge or understanding of the
requirements for applying for withdrawal without academic penalty is not a
valid reason for applying outside these timeframes.
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1. Visa type
Student

Other (please specify visa type)

2. Leave of absence details (only complete this section if you are applying for leave)
Leave of absence

(see Section 4)

I request leave of absence (Intermission) from my studies in the above course from

........../........./.........

until the commencement of ............................................................. (first/second) semester, 20..............

Please indicate your reason/s for Leave of Absence and attach documentary evidence.
.........................................................................................................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................................................................................................

3. Course cancellation (only complete this section if you are cancelling your course)
I wish to cancel my course

If you are in a pathway program, please indicate below which courses you wish to cancel:

4. I wish to apply for withdrawal without penalty (please indicate where possible):
You may be eligible for withdrawal without academic and/or financial penalty or refund where you can demonstrate that special circumstances necessitated the withdrawal,
Academic penalty

Financial penalty (Remittance or refund of tuition fees)

Both

5. Details of the unit/s for which withdrawal without penalty is sought

Office use only

Course
code

Teaching
period

Year

Unit code

Census
WWAP
date date

If you have indicated that you wish to be considered for withdrawal without academic or financial penalty in Section 5, relevant documentation must
be provided to support your special circumstances.
Unit additions and withdrawal dates table can be accessed at www.student.qut.edu.au/about/key-dates-and-academic-calendar/key-dates
Relevant documentation required for Special Circumstances is listed at www.student.qut.edu.au/studying/special-circumstances

Privacy
Details of QUTs practices regarding student information and privacy see www.qut.edu.au/privacy If you are unable to access the internet, you can
contact QUT Student Centre in person, phone 07 3138 2000 or email askqut@qut.edu.au for this information.

6. Declaration
By submitting this application I agree to comply with the statutes and rules of Queensland University of Technology that apply to me. I further agree
that I am subject to and must comply with any policies or procedures of the University governing my conduct as a student, and academic matters
affecting my studies, including but not limited to, the QUT Student Code of Conduct www.mopp.qut.edu.au/E/E_02_01.jsp and the procedures for
management of student discipline www.mopp.qut.edu.au/E/E_08_01.jsp
I declare that to the best of my knowledge the information supplied by me is true, correct and complete in every respect. I acknowledge that the
submission of false, incorrect, incomplete or misleading information may result in delays in processing.
I acknowledge that I am responsible for the payment of all student fees and charges applying to my admission and study at QUT.
QUT shall not be liable for any failure to provide services (including lectures, tutorials or examination results) or any teaching or other materials to
students where such failure is due to circumstances beyond QUTs control. Such circumstances include, but are not limited to, natural disasters,
malicious damage, outbreak of pandemic disease, industrial action or strikes, acts of war or acts of God.

Students signature .................................................................................................................................................................................................................. Date ............/............/............

Print Form. Please ensure form is signed before lodging.

Page 2 of 3

Student Business Services use only

A. APPLICATION ASSESSMENT AND APPROVAL
Date logged
LOA

............../............./..............

N/A

Student number

Yes

Course cancellation

N/A

Yes

Was the semester of study under consideration within the last 12 months? ..........................................................................
If not has documentation been provided?

Yes

Yes

No

No

(If NO, please do not complete this section. Advise the applicant that they are TOO LATE for consideration unless they can provide evidence why
they could not apply within the last 12 months.)
Yes

Withdrawal without academic penalty (WWAP) outcome

Special circumstances

Medical

Course

No

Employment

Family / Personal

Uni error

WWAP Comment ............................................................................................................................................................................................................

............................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................
.........................................................................................................................................................................................................................................
............................................................................................................................................................................................................................................
Processing Officers name .......................................................................... Signature.........................................................Date............../............./..............
Withdrawal without financial penalty (WWFP) outcome
Special circumstances

Yes

Medical

Course

No

Employment

Retention only / Late fee

Family / Personal

Uni error

WWFP Comment..................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
..................................................................................................................................................................................................................................................
Managers

name ..........................................................................................Signature.........................................................Date............../............./..............

Please complete the table below. Ensure you enter all details and follow the checklist down FOR THAT UNIT, ticking all procedures as they are
completed.
C. WWAP / WWFP PROCESSING (tick as you complete).
Unit Code
1. If failed status (if enrolled, go to 2): unratify
and uncertify (ESR)
2. Change unit WD date to census + 1 (ESR)
3. Ratify results if required. (ESR)
4. Sponsor student YES/NO
If Yes refer to sponsorship officer
5. Fee (raised in Callista): process Remission
Pre-SAMS international student
6. Tuition fee (raised in SAMS): Pre-reporting
Sponsorship set up (SFC)
7. Tuition fee (raised in SAMS): Post-reporting
Student fee reversed (SFC)
8. REFUND Form submitted

Yes

No g

9. Comments in SAMS

ESR

SFC

10. Noted in RC Spreadsheet

ESR

SFC

11. Correspondence email

Yes

Include in email

Amount ..................................

ESR processing officers name ...................................................................................... Signature ..................................................................................... Date ............/............/............

SFC processing officers name ....................................................................................... Signature ..................................................................................... Date ............/............/............
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