Application for Post-Census Remission of Debt (PCRD) due to special circumstances

This form is provided to allow domestic students to apply for a remission of their Swinburne study fees after the census deadline due to special circumstances.

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Personal details

Student ID:

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Surname/Family name:

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Given name(s):
(leave space between names)

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Phone number:

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Email:

Please enter a valid email address

Address:

Course details

Course Code:

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Course Title:

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Study Type:

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Campus:

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Course Type:

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IMPORTANT: Applying for all the units you are enrolled into for a study period amounts to taking a break from your study. Before applying for a PCRD, you must first apply for an authorised Leave of Absence or if appropriate, withdraw from your course.

Have you applied and been granted a Leave of Absence

Yes No
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Units for which you are applying for a Post-Census Remission of Debt

Detail at least one unit :

Unit Code	Unit Title	Teaching Period	Year
This field is required	This field is required	This field is required	This field is required

Details surrounding your special circumstance

You must provide an explanation below describing your special circumstances, and submit your independent supporting documentation as evidence of special circumstances.

For Example:

Medical reasons (e.g. occurring or worsening after Census date)
Family reasons (e.g. death, illness)
Employment related reasons (e.g. compulsory transfer, change of hours)

Visit Ask George for possible answers to your course or enrolment related reason.

Outline your circumstances :

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1000 characters left

Attach supporting documentation

You must attach evidence as supporting documentation. Medical certificates must have a PROVIDER Number.
Accepted document formats are: GIF, JPG, DOC, DOCX, PDF. Maximum document size is 2MB.

We do not accept Registered Practitioner Medical Impact Statements, Accessibility Registration Forms or Hospital discharge summaries.

Attach documentation :

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A maximum of 5 documents can be submitted with this form, if you need to submit more documents, please email these to remissions@swin.edu.au with your name, student ID and the receipt number of this application.

Privacy Statement and Disclaimer

By Submitting this form:

I declare that the information supplied on this form and the information given in support of my application is correct and complete.
I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application may result in a delay in processing.
I acknowledge that the incomplete or incorrect information provided in the application may result in application cancellation.
I understand that Swinburne University of Technology collects, uses and destroys personal information used for the purpose of assessing and managing my Post Census Remission of Debt application in accordance with the Privacy Policy.

I agree to the terms stated above

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