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Request Record

Student Name

Student ID

Type Request

Course Name

Contact Number

Deferral/Suspension (From Date)

Deferral/Suspension (To Date)

Cancellation Date

Reason:
(Please provide a reason below & attach any supporting documentation and refer to the policy when lodging request)
Attach any document here
Travelling overseas
Note: If Yes (Flight tickets outlining departure and return)
Yes No

Supporting document (Medical Certificate; Death Certificate or any other compelling and compassionate reason document)

Clear