STUDENT WITHDRAWAL FORM

Please use this form to withdraw from your programme and papers.
Students should be aware that simply “dropping out” rather than formally withdrawing from a paper or
programme would result in a Did Not Complete (DNC) grade on your academic record. Additionally, such
students will remain liable for outstanding University fees.
You must make an appointment to see either your Programme Leader/Major Co-
ordinator or the Manager of Faculty Programme Administration Office and take
this form with you.

SURNAME:　Leung　　 ID No:0938889
FIRST NAME(S): Tsz Pui Lawrence Date of Birth:10/Aug/1991
ADDRESS: 15 Gretna Green, Browns Bay, North shore,
Auckland
TELEPHONE NO: 02102601903

PROGRAMME NAME: Certificate in Applied Science

PROGRAMME CODE: AK1018

List all papers you are withdrawing from:

Paper Name Paper Code
1.Ecology and Evolution 775317
2.Statistics 4 714285
3.Foundation Human Anatomy and Physiology 774601
4.General and Organic Chemistry 775205
5.
6.
7.
8.

Reason for Withdrawing:

It is because i find hard to do this course and
i really want to get refund from semester 2
and go to massey uni and apply do the
fundamental chemistry and biology for me to
get into nutrition.
Do you wish to apply for refund?
Yes
If ‘Yes”, please complete Student Refund
Application form and provide
documentation to support your application,
e.g. Medical Certificate.
Student signature: Date: 10/6/2010

Comments:

Academic Approval:
Yes / No
Signature: Date:
(Programme Leader / Major Co-ordinator / Manager
of FPAO)

Entered on Arion: Y / N Date: _______________________

Signed: __________________________________________
Faculty Programme Administrator