Withdrawal from the program

If you wish to withdraw from the University of Melbourne Extension Program at any point after you have enrolled, it is essential that you notify us as soon as possible by completing the form below. Before withdrawing, you are strongly recommended to discuss your circumstances with your Extension Program teacher, lecturer, tutor or Year 12 Coordinator.

Note: If you withdraw from your Extension Program studies, you will not be disadvantaged if you apply to study at the University of Melbourne or any other institution in the future. Similarly, if you fail an Extension Program subject, your result will be automatically removed from the University database.

Student number: *

Family name: *

Given name: *

Date of birth: *

Day Month Year

Email address: *

Extension Program subject:

Teaching location: *

Home school: *

Please indicate your reason(s) for withdrawing:

Please list other reason/s or additional comments:

I authorise the University of Melbourne to cancel my enrolment in the University of Melbourne Extension Program. *