Please ensure that your student account is in credit and that you are eligible for a refund when submitting this form. Continuing students with a credit balance are encouraged to offset this amount against their fees in the next semester.

    Student Number

    Date of Birth

    First Name

    Last Name

    Mobile Number

    Program Name

    Email Address

    Current Address*

    Refund Amount (AUD)

    Application fees of $200 are not refundable

    Reason for Refund

    Dropped Course/sExcess funds/ Overpayment of feesReduced study load approvedWWP ApprovedStudent Visa not granted (evidence required)Other

    Please specify

    Payment Details

    Please complete ONE refund method below (e.g. TT, EFT, Credit Card) * If fees were paid by credit card, refunds MUST be returned to the originating credit card. *Fees paid by international bank transfer refunds will be returned to the student's home country as per USQ's Refund Policy. For more information please refer to the USQ website for the Refund of Student Fees Policy and Procedure.

    Bank transfer - International Bank

    Bank Name

    Bank Address

    Branch

    Account Name

    Account Number

    Swift Code

    Bank transfer - Australian Bank

    Bank Name

    Bank Address

    Branch

    Account Name

    Account Number

    BSB

    CREDIT CARD- Please select from the following options:

    I paid my fees online through the USQ Sydney website.

    The refund will be credited back against the originating credit card - you are not required to provide any further details.

    I paid my fees in-person or over the phone.

    The refund will be credited back against the originating credit card - USQ Sydney staff will contact you to obtain full credit card details.

    PRIVACY COLLECTION STATEMENT

    USQ Sydney collects personal information to assist the University in providing tertiary education and related ancillary services and to be able to contact you regarding enrolment, assessment and associated USQ services. The information may be made available to Commonwealth and State agencies and the Tuition Protection Service Director and Secretary pursuant to obligations under the Education Services for Overseas Student Act 2000 and National Code or other legislative requirements. Personal information will not be disclosed to third parties other than to a USQ approved agent, partner or any organisation who provides sponsorship to you for your studies, without your consent unless required by law.

    STUDENT DECLARATION

    I declare that the information provided on this form is true and complete and that is my responsibility to provide all necessary
    documentation to support my request for refund.
    I agree and have read through the USQ Sydney refund policy for international students. I understand there is a bank charge for refunds to international bank accounts. I understand my refund will be processed within 10 days from the date that USQ Sydney has received all required documentation. Application fees of $200 are not refundable.

    Student Signature

    Date