This form is to be used for the refund of fees in special circumstances. It cannot be used for altering academic results.

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1 APPLICATION FORM REFUND OF DEBT IN SPECIAL CIRCUMSTANCES Fee paying domestic and international students This form is to be used for the refund of fees in special circumstances. It cannot be used for altering academic results. Who can use this form? Only international students and domestic full fee paying students not accessing a HELP scheme can use this form. If you are a Commonwealth supported student, or are accessing HECS-HELP or FEE-HELP please use the Application form for Remission of debt in Special Circumstances. What is this form used for? This form should not be used to remove fail grades from your record or improving your WAM. Please use this form if you withdrew from your studies after census date due to special circumstances, or you have been prevented from completing or withdrawing from a unit(s) due to special circumstances. You cannot apply for a Refund of debt in special circumstances if you have successfully completed the unit. What are special circumstances? You must be able to demonstrate that the special circumstance(s): were beyond your control, and did not make their full impact on you until on, or after, the census date, and made it impracticable for you to complete the requirements for the unit(s) in the period during which you undertook, or were to undertake, the unit(s) Examples of special circumstances include: medical circumstances (e.g. onset of a medical condition or changes in your pre-existing medical condition on or after the census date that meant you were unable to continue studying) family/personal circumstances (e.g. death or severe medical problems within your family) employment related circumstances (e.g. your employer changed your employment conditions and you were unable to continue studying) The following is not considered special circumstances: failing to read documentation provided by Deakin University about your course not realising you were enrolled in the unit choosing to increase your hours of work or undertake additional employment financial pressures What does beyond your control mean? The circumstances must be unusual, uncommon or abnormal. For example a lack of knowledge or understanding of your requirements as a student is not considered to be beyond your control. What is the timeframe for the special circumstances? The special circumstances must occur: after the census date or before the census date, but the full effect or impact does not become apparent until after that day

2 What does impracticable to complete the unit of study requirements mean? You may be unable to complete the requirements of a unit, for example, if you were unable to: undertake the necessary study required, or attend sufficient lectures or tutorials or meet other compulsory course requirements, or complete the required assessable work, or sit the required examinations, or complete any other course requirements because of your inability to meet the above. What is census date? The census date is the last date you can withdraw from a unit without being financially liable i.e. having to pay for the unit. The census date is promoted on the Deakin website and not knowing the census date is not considered a special circumstance for Refund of debt. If your special circumstances are known to you before census date your application must demonstrate the date when your circumstances changed or escalated and the impact they had on your ability to complete your studies. What evidence should you provide to support your application? For your application to be considered, you need to provide originals or certified documentation in support of your statements. These include: medical certificates from doctors, counsellors or other medical health professionals, confirming the circumstances and dates (all medical documentation should be specific to you, the student) letter from your employer detailing they have made changes to your employment (i.e. work hours, location) and dates death certificates. correspondence from Deakin such as s, letters etc. These must include the staff members name and applicable dates. other documentation which can confirm your application / statement. Please be aware your application will not be reviewed if documentation is not supplied or is incomplete. The supporting documentation you provide must relate to the period being applied for. How do I complete section D - Details of Special Circumstances? When completing section D - Details of your special circumstances, please ensure you provide a list of dates (dd/mm/yyyy) and events which impacted your studies in the period being applied for. If your application covers more than one period, please detail the dates and events on a separate application form for each study period. Please do use the term such as refer to my attached supporting documents. You must provide a list of dates and events in this section. Please ensure the list of dates and events relate to the period being applied for. Before submitting your application, please read your statement to ensure it clearly demonstrates: when your circumstance(s) changed the details of your special circumstance(s) the impact of your special circumstance(s) on your study The information you provide should be concise and relevant to the period being applied for.

3 How will this application impact my academic record? A refund of debt does not mean the pre-census backdating of a unit. This process should not be used to remove fail grades from your record or to improve your WAM. What are the timeframes? Applications must be made using this form, within 12 months of either the date of withdrawal from the unit, or if the unit was not withdrawn, within 12 months of the last date of the semester/trimester in which the unit was undertaken. Applications for study periods outside of this 12 month period may be considered if you can prove that the application could not have been made within the required time limit. You must provide original or certified evidence of the circumstances that prevented you from applying within the 12 month time frame. If you are still enrolled in or have an incomplete grade (e.g. RI) for a unit you are applying for, your application will not be considered until you have withdrawn from the unit or a fail grade is applied. Where to send your application? (applications not accepted by ) Applications and supporting documentation can be handed in at Student Central on your campus or mailed to: Student Finance Division of Student Administration Deakin University Locked Bag Geelong VIC 3220 Australia What happens next? Deakin University will respond to you within 28 days from the date the application is received by the Division of Student Administration. Is there an appeal process? If you are not satisfied with the decision, you may apply to the Reviewer for a review of that decision. This appeal must be in writing, setting out the reason for your request. The appeal application must be made within 28 days of receiving notification of the decision. Reviews cannot be processed outside this timeframe.

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5 APPLICATION FORM REFUND OF DEBT IN SPECIAL CIRCUMSTANCES Fee paying international and domestic students This form is not to be used for altering academic results Please complete all sections prior to submitting your application SECTION A: STUDENT DETAILS STUDENT ID: DATE OF BIRTH: SURNAME: GIVEN NAME(S): ADDRESS: STATE: POSTCODE: PHONE: SECTION B: COURSE DETAILS COURSE CODE: NAME OF COURSE: SECTION C: REFUND OF DEBT ELIGIBILTY QUESTIONS (please answer all relevant questions) 1. WHAT IS YOUR SPECIAL CIRCUMSTANCE(S)? Medical Employment Related Family Related 2. ARE YOUR CIRCUMSTANCES PRE-EXISTING? (i.e. were you aware of your circumstances, did they exist prior to census date?) Yes: You must provide proof of an escalation/change in the pre-existing condition (go to Q3) No: Go to Q4 3. DID YOUR CIRCUMSTANCE(S) ESCALATE/CHANGE AFTER CENSUS DATE? Yes: There must be an escalation after census date (go to Q4) No: You are not eligible for Refund of Debt 4. DID YOU STUDY YOUR UNIT OVER 12 MONTHS AGO? Yes: Complete Section G (then go to Q5) No: Go to Q5 5. HAVE YOU APPLIED FOR SPECIAL CONSIDERATION OR AN EXTENSION? Yes: Please provide details of your application (go to Q6) No: Go to Q6 Deakin University CRICOS Provider Code: 00113B

6 6. HAVE YOU APPLIED FOR A SUPPLEMENTARY EXAM? Yes: Please provide supporting documentation relevant to the date of your supplementary exam (go to Q7) No: Go to Q7 7. ARE YOU APPLYING FOR TWO STUDY PERIODS? Yes: Fill out a separate application form for each study period (go to Q8) No: Go to Q8 8. ARE YOU APPLYING BASED ON AN ACADEMIC PROGRESS HEARING OUTCOME DECIDED AFTER CENSUS DATE? Please note, if a decision is still pending, your application cannot be assessed until after the FAPDC has made a decision and notified you of their decision. Yes: If the decision was made after the census date, you don t need to apply for Refund of debt. You will be withdrawn from your units and receive a credit for the tuition fees paid No: If the decision was before census date, you must provide a statement and supporting documents explaining why you did not withdraw from your units before the census date. 9. HAVE YOU CONSULTED YOUR UNIT CHAIR, LECTURER OR OTHER FACULTY STAFF MEMBER ABOUT YOUR DIFFICULTIES? Yes: Please attach relevent documentation (go to Q10) No: We may contact the Faculty to discuss your application (go to Q10) 10. HAVE YOU ATTACHED SUPPORTING DOCUMENTS? Please note, medical certificates, employers letters and other relevant documents must be on letterhead and if not supplied as an original must be a certified copy. Yes: (go to Q11) No: You cannot apply for Refund of debt without supporting documentation attached. 11. DO YOUR SUPPORTING DOCUMENTS EXPLAIN HOW YOUR SPECIAL CIRCUMSTANCES MADE IT IMPOSSIBLE FOR YOU TO COMPLETE THE REQUIREMENTS OF YOUR STUDY? Yes: (go to Q12) No: Supporting documentation for you must explain how your circumstances significantly affected your ability to study and made it impossible to complete the requirements of your study. You must seek additional documentation before submitting your application. 12. ARE YOUR SUPPORTING DOCUMENTS RELEVANT? Yes: (go to Section D) No: You must attach documents relevant to you circumstances and the study period in your application. Do not send: documentation which pre-dates the relevant study period travel itineries * All medical documentation must be in hospital admission statements* the form of a letter from your doctor, pharmacy statement* indicating the date of change, condition pathology report* and impact on your studies. Special Consideration medical form* Deakin University CRICOS Provider Code: 00113B

7 SECTION D: UNITS DETAILS FOR WHICH THE REFUND IS SOUGHT (please use a seperate form for each study period) STUDY PERIOD E.g. Trimester 1 YEAR E.g UNIT CODE(S) E.g. MAA101 UNIT NAME(S) E.g. Accounting101 DATE OF WITHDRAWAL FROM UNIT SECTION E: UNITS SUCCESSFULLY COMPLETED IN THE SAME STUDY PERIOD STUDY PERIOD E.g. Trimester 1 YEAR E.g UNIT CODE(S) E.g. MAA101 UNIT NAME(S) E.g. Accounting101 GRADES RECEIVED SECTION F: DETAILS OF YOUR SPECIAL CIRCUMSTANCES Please provide details of your special circumstances, ensure you explain how your circumstances: Changed after census date Prevented you from completingyour studies; and Were beyond your control DATE (AFTER CENSUS DATE) CIRCUMSTANCES CHANGED DETAILS OF CIRCUMSTANCES IMPACT ON YOUR ABILITY TO STUDY If you need more space please attach a separate sheet. Deakin University CRICOS Provider Code: 00113B

8 SECTION G - STATEMENT EXPLAINING APPLICATION OUTSIDE 12 MONTH TIME FRAME If you need more space please attach a separate sheet. SECTION H - DECLARATION I declare the information and documentation supplied by me in this application is to the best of my knowledge correct. I acknowledge that giving false or misleading information or documenation is a serious offence and I may be prosecuted if I knowingly make any false or misleading statements. I acknowledge it is my responsibility to establish that special circumstances apply to my situation and provide independent supporting documentation to confirm the dates and events provided. I acknowledge withholding relevant information relating to my application will result in a delay in processing and result in a decision based on the information I have provided in this application. I acknowledge that my application will not be reviewed until I withdraw from the unit or a fail grade is applied. Signature of applicant Date Please read and confirm your application meets the following: I understand this form is for refund of tuition fees, not removing fail grades. I have read and understood the instructions for use section I have completed Sections A, B, C and D I have completed Section C and provided a list of dates and events which explain the special circumstances which apply. I understand my application will be returned to me if I do not provide detailed information in this section. (please ensure the dates provided are relevant to the study period you are applying for) I have withdrawn or have received a fail grade for the unit(s) being applied for. I have attached original or certified copies of independent supporting documentation which confirm my special circumstances. I understand my application will be returned to me if I do not provide independent supporting documentation. (Please ensure the dates provided are relevant to the study period you are applying for). I have read and signed the declaration in Section H. When complete, this form and supporting documentation can be lodged at Student Central on your campus, or mailed to: Fees, Scholarships and Financial Assistance Division of Student Administration Deakin University Locked Bag Geelong VIC 3220 Australia Deakin University CRICOS Provider Code: 00113B