If you are changing your enrolment in any way or withdrawing from any paper(s)/qualification, this
form must be completed, signed and received by UCOL. Complete Sections A and B and other relevant
sections, then sign and date the declaration in Section G. Return the completes, signed form to the
UCOL Information Centre or Registry Services.
First Name(s) Surname
Previous Name(s)
(if applicable)
Student ID Number
(if known)
Date of Birth
/ /
Are you currently receiving or have you applied for a Student Loan or Allowance? Yes No
If “Yes”, the change to your enrolment may affect you eligibility for a loan or allowance. You may wish to contact
StudyLink to confirm your eligibility.
If you are receiving a Student Loan or Student Allowance, you will need to complete the Loan or Allowance Change of
Circumstances form. Contact StudyLink for further details.
Please change my address(es) to:
Contact Address
(Term time)
Phone - Day Night Cell
Permanent Address
(if different from Contact Address)
Personal Email Address
To which address should we send correspondence? Contact Permanent
Is this change of address the only reason you are completing this form?
Yes
Go to Section G
No
Go to Section D
Please tick the box which best represents your change in status, and fill in the date from which this event took effect. You will
need to provide proof of this change (e.g. your stamped passport, certificate of citizenship or letter of confirmation).
I am no longer a permanent resident of New Zealand Date of change
I have been granted permanent residency or citizenship of New Zealand Date of change
Change of Details/Circumstances
UCOL is a polytechnic under the Education
Act 1989.
A ALL STUDENTS
B LOANS & ALLOWANCES
C CHANGE OF ADDRESS
CHANGE OF RESIDENCY
OR CITIZENSHIP
FOR OFFICE USE ONLY
Date of Receipt
Received by
/ /
/ /
/ /
D
WITHDRAWAL FROM
PAPER(S)/QUALIFICATION
ENROLMENT INTO
PAPER(S)/QUALIFICATION
E
F
Note 1 -To be eligible for a partial refund
(less the non-refundable portion), your
withdrawal must comply with the terms
of UCOLs refund policy and paper(s)/
qualification withdrawal timeframe as set
out in the current UCOL Admission and
Enrolment Guide and Form.
Note 2- There is a different refund policy
for International Students. Please contact
the UCOL Information Centre for further
information.
Note 1 - If the fees for the paper(s)/
qualification you transfer to are higher than
the fees for the paper(s)/qualification you are
enrolled in and if you are transferring within
the relevant period in the required manner
then you agree to pay the difference in the
fees to UCOL.
Note 2 - If your withdrawal from the
paper(s)/qualification is not within the
relevant refund period in the required
manner, then you must pay the full fees for
the paper(s)/qualification you withdraw
from, and you agree to pay the full fees for
the paper(s)/qualification you transfer to.
Your admission and enrolment in the
paper(s)/qualification you are seeking to
transfer to is subject to UCOL sending you
a confirmation letter and otherwise on the
terms and conditions of the UCOL Admission
and Enrolment Form and Guide.
List below full details of the Paper(s)/Qualification you are withdrawing from:
Name of Paper(s)/Qualification:
Have you completed any papers? Yes No
Please tick the appropriate box with your reason for withdrawal:
Changed paper/qualification Changed paper/qualification after UCOL advice
Paper/qualification is too difficult Paper/programme is not what I thought
Studying elsewhere Did not mean to enrol
Changed semester Financial
Moving town Going back to School
Medical/health reasons Personal
Got a job/work committments Going overseas/travelling
Other, please state
FOR OFFICE USE ONLY
Programme Leader/Head of School Signature Date / /
Name of Paper(s)/Qualification transferring to
(include speciality area if known)
Do you expect to graduate this year? Yes No
Reason for transfer
(if applicable)
International Students:
Your enrolment is subject to you providing a certified true copy to the UCOL Information Centre of your student
visa, for the paper(s)/qualification you transfer to.
Where I am transferring to other paper(s)/qualification at UCOL or where I am changing (either by adding paper(s)/qualification)
or ceasing studying some of the paper(s)/qualification I was previously enrolled in, then I agree:
i) That my transfer to the paper(s)/qualification is subject to UCOL, at UCOLs sole option, confirming my enrolment.
ii) That the provisions of the UCOL Admission and Enrolment Guide and UCOL Admission and Enrolment Form continue to apply
to me and that I am bound by that agreement except to the extent as expressly varied in this form, including, without limitation,
the privacy provisions.
iii) That nothing in this form releases me from my agreement with UCOL as set out in the UCOL Admission and Enrolment Guide
and the UCOL Admission and Enrolment Form.
iv) That the date of withdrawal is deemed to be that date inserted by UCOL on this form being the date of receipt of this form
completed and signed by me.
I hereby declare that the information provided by me on this form is true and correct.
Student Signature Date / /
Guardian Signature
(if under 18)
Date / /
Programme Leader Signature Date / /
You have now completed this form. Please return this form to us at:
UCOL, FREEPOST 460, PRIVATE BAG 11022, PALMERSTON NORTH
AGREEMENTG
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