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Application For Fee Deferral

This document is an application for a fee deferral submitted by a student. It contains the student's personal details and a request to pay tuition fees for an upcoming semester in installments by specified dates. The student provides their reason for the request and signatures from themselves and their parents/guardians. The form also collects emergency contact information. It notes that the form must be brought when enrolling and paying fees and that payment is to be made at the student center. Space is provided for office use to approve or deny the request.

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32 views2 pages

Application For Fee Deferral

This document is an application for a fee deferral submitted by a student. It contains the student's personal details and a request to pay tuition fees for an upcoming semester in installments by specified dates. The student provides their reason for the request and signatures from themselves and their parents/guardians. The form also collects emergency contact information. It notes that the form must be brought when enrolling and paying fees and that payment is to be made at the student center. Space is provided for office use to approve or deny the request.

Uploaded by

Patrick
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UTS:INSEARCH Student ID Number

INS0006

Application for fee deferral


Student details
Family Name:
Given Names:
Date of birth (DD/MM/YYYY):
Unit No:

Street No:

Street Name:
Suburb: Postcode:
Telephone: Mobile:
E-mail:

Instalment plan
I request additional time to pay my tuition fees as detailed below.

Current credit:

For the semester commencing:

Amount of fees now due:

I will pay the above fees by the following date(s):


Amount: $

Date(DD/MM/YYYY):

(2nd Instalment if required)

Amount: $

Date(DD/MM/YYYY):

(3rd Instalment if required)

Amount: $

Date(DD/MM/YYYY):

Reason for request:

Funds will be remitted by:

Student Signature: Date (DD/MM/YYYY):


INS0006
(Page 1 of 2)

Name and address of Parents or next of kin


Family Name:
Given Names:
Relationship to student:
Unit No:

Street No:

Street Name:
Suburb: Postcode:
Telephone: Mobile:
E-mail:

Name and contact details of person known to student who does not live with them
Family Name:
Given Names:
Unit No:

Street No:

Street Name:
Suburb: Postcode:
Telephone: Mobile:
E-mail:
Note: you must bring this form when enrolling and paying fees.
The above fees must be paid at the INSEARCH student centre.

OFFICE USE ONLY


Request approved

Revised

Recieved Date (DD/MM/YYYY):


Initials:

Denied

Date (DD/MM/YYYY):

INSEARCH Limited is a controlled entity of the University of Technology, Sydney (UTS).


INSEARCH Limited is a registered non self accrediting higher education institution and a pathway provider to UTS.
INSEARCH CRICOS provider code: 00859D, UTS CRICOS provider code: 00099F
Version July 2014 1405_0714

INS0006
(Page 2 of 2)

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