STUDENT DEFERRAL FORM
AMPA Deferral Form
This form is to be completed if you need to take one or more Trimester's leave during the duration of your registered course. Please ensure you have consulted the Student Services Team or Head of Department before completing this form.

NB: This form is to be submitted PRIOR to the Census Date, otherwise you will incur the full financial liability for the trimester.

FULL Name *
Your answer
Student Number *
Your answer
Contact Number *
Your answer
Email Address *
Your answer
Course *
Required
Study Mode *
Required
Do you wish to be kept on the mailing list for events & news notifications? *
Please provide feedback on ways to improve the course (optional)
Your answer
Reason *
Required
Expected Date of Return *
Date
MM
/
DD
/
YYYY
Submit
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