Part 1 Information and instructions

Part 1 Information and instructions Application for remission (removal) of debt in special circumstances Who CAN use this form? Eligible local higher education or TAFE students who withdraw from a program or course after the census date due to special circumstances, or who have been prevented from completing or withdrawing from a course due to special circumstances, can use this form to apply to have their: HECS-HELP debt remitted up-front payment of a student contribution refunded FEE-HELP or VET FEE-HELP balance remitted* HECS-HELP debt for a unit consisting wholly of work experience in industry (WEI) remitted up-front payment of a student contribution for a unit consisting wholly of WEI refunded. Special circumstances are defined in column 2. Note: A student s FEE-HELP debt for a unit of study will be remitted if the student s FEE-HELP balance is re-credited. Who CANNOT use this form? Local full-fee students who have not completed a Request for FEE-HELP assistance form before the census date or have not accessed a FEE-HELP loan. Local TAFE students who have not completed a Request for VET FEE-HELP assistance form before the census date or have not accessed a VET FEE-HELP loan. Higher education students who are not Commonwealth supported. International students. Students who successfully completed the course/s. Students who submitted an Enrolment variation, Cancellation of enrolment or Leave of absence form prior to the census date but believe their form has not been processed (or has been processed incorrectly). Students in this circumstance should contact the school that offers their program and explain their concerns. Time limits for applying An application for a re-credit or remission must be made, in writing, within 12 months of the withdrawal date. If the applicant has not withdrawn, the application must be made within 12 months of the last day of the semester in which the applicant was enrolled in the course. Applications lodged outside this 12 month period may be considered if the applicant can prove that the application could not have been submitted within the required time line. The applicant must provide evidence of the circumstances that prevented submission of a timely application. Note: The time limit for applications to remit debts due to special circumstances incurred under the Higher Education Funding Act 1988 (pre-2005 debts) has lapsed. What do I need to demonstrate in order to have my application approved? For your application to be successful you must be able to demonstrate, with independent supporting documentation (a self-supporting statement is not sufficient evidence), that: 1. due to special circumstances, you were unable to complete the requirements of your course/s, i.e. you were unable to: i. undertake the necessary private study required, attend sufficient lectures or tutorials, or meet other compulsory course requirements; or ii. complete the required assessable work; or iii. sit the required examinations, or iv. complete any other course requirements because of your inability to meet (i), (ii) or (iii), AND 2. those special circumstances did not make their full impact until on or after the census date, i.e. your circumstances occurred: i. before the census date, but worsened after that day; or ii. before the census date, but the full effect or magnitude did not become apparent until on or after that day, or iii. on or after the census date. AND 3. those special circumstances were beyond your control, i.e. a situation occurred that a reasonable person would consider was not due to your action or inaction, either directly or indirectly, and for which you were not responsible. This situation must be unusual, uncommon or abnormal. Note: A lack of knowledge or understanding of the University s rules and regulations or the rules that govern HECS-HELP, FEE- HELP, up-front fees or work experience in industry (WEI) is not considered to be beyond your control. What are special circumstances? Special circumstances may include: Medical reasons You will need to provide an impact assessment statement (see page 4 of the application form), completed by your medical/health practitioner, to substantiate your claim/s. This statement should demonstrate: the date your medical condition began or changed how your condition affected your ability to study, and when it became apparent that you could not continue your studies. Family/personal reasons You will need to provide a statement from a doctor, counsellor or independent member of the community (e.g. a Justice of the Peace or a minister of religion) to demonstrate: the date your personal circumstances began or changed how your circumstances affected your ability to study, and when it became apparent you could not continue your studies. Employment related reasons You will need to provide a statement from your employer which states: your previous work hours and location your current work hours and location and the date these were changed the reason for changed hours and location. Owner: Assessment Support Application for remission (removal) of debt in special circumstances 0313 Page 1 of 5

These reasons must demonstrate that, after the census date, your employment status or arrangements changed unexpectedly due to circumstances beyond your control, and you were unable to complete your studies. Note: Choosing to increase your hours of work or undertake additional employment are not regarded as circumstances beyond your control. HECS-HELP, FEE-HELP balance and/or up-front contribution payments will not be re-credited in such circumstances. Course related reasons Your school/college changed the arrangements for your unit or course after the census date and, as a result, you were disadvantaged to the extent that you were unable to complete the requirements of the course. You will need to supply supporting documentation from your school/college to substantiate your claim. False or misleading statements or information It is a criminal offence to knowingly make a false or misleading statement or to otherwise knowingly supply false or misleading information in connection with an application for re-crediting or remission. Applicants who knowingly supply false or misleading statements or information may be liable to criminal prosecution. What happens once I have submitted my application? 1. RMIT will send you an acknowledgement letter confirming the date your application was received and a reference number. The letter will also tell you how long it will take RMIT to assess your application. 2. Once your application is processed, RMIT will advise you in writing of the outcome. If the decision is in your favour, this letter may also describe any further steps you may need to take to receive a refund of any up-front payments you have made. 3. If you are not satisfied with the decision, you may apply to have the decision reconsidered by a senior, independent RMIT University review officer. You must apply for reconsideration in writing, quoting the application file reference number, within 28 days of the date the notification of the outcome was sent. 4. If, after your application has been reconsidered, you remain unsatisfied with the result, you may apply to the Administrative Appeals Tribunal (AAT) for a review of the decision. Please note that you may have to pay an application fee. Refer to the Administrative Appeals Tribunal website at www.aat.gov.au for information concerning this process. Where do I submit this application form? An application may be lodged as follows: Scan application and supporting evidence and email to HESA.remissions@rmit.edu.au Via mail to: Remissions and re-credit applications Assessment Support Academic Registrar s Group RMIT University GPO Box 2476 Melbourne VIC 3001 Via facsimile to: +61 3 9925 8845 In person to: The Office of the Academic Registrar RMIT City campus Building 88, Level 8 440 Elizabeth Street, Melbourne Owner: Assessment Support Application for remission (removal) of debt in special circumstances 0313 Page 2 of 5

POL/2008/00367 PERSONAL DETAILS Please complete using blue or black ink Student no. Date of birth (dd/mm/yyyy) Title (Mr/Mrs/Ms/Dr, etc.) Family name Given name/s Application for remission (removal) of debt in special circumstances HECS-HELP, FEE-HELP, VET FEE-HELP and up-front student contribution Program name Program code School Academic career (please tick): TAFE Undergraduate Postgraduate Research Are you currently enrolled as an onshore international student? (please tick) Yes No Part 2 Application form Section A contact details Number Street Suburb State Country Postcode Telephone no. Mobile telephone no. Email address If you need to change your address details while your application is being processed, please contact HESA Remissions by email at HESA.remissions@rmit.edu.au or by fax: +61 3 9925 8845. Section B details of course for which you are seeking re-credit or remittance Semester e.g. 1, 2, Summer/Spring Year e.g. 2012 Course code e.g. HUSO2257 Class no. Course name Section C special circumstances You must provide information on your special circumstances, specifically how your circumstances: were beyond your control did not make their full impact until on or after the census date prevented you from completing the requirements for the relevant unit/s of study. If there is insufficient space below, please attach your statement and write see attached in this section. Owner: Assessment Support Application for remission (removal) of debt in special circumstances 0313 Page 3 of 5

Name of applicant: Impact assessment statement Special circumstances on medical or health grounds Note: If your claim is based on medical or health grounds this section must be completed in full by an independent registered medical/ health practitioner. You may also include a supporting letter from an independent qualified practitioner in addition to this impact assessment statement. A separate medical certificate is generally insufficient. I agree to my medical/health practitioner providing clarification of the following information to RMIT University. Signature of student: Medical/health practitioner to complete this section On (date/s of consultation) I, examined I have determined that he/she suffered from: student s name in BLOCK LETTERS (name) a registered medical/health practitioner diagnosis description/name of condition to be provided with student s consent OR The student stated that he/she suffered from: description/name of condition The condition was (please tick one): short term temporary (3 6 months) ongoing permanent episodic/fluctuating The impact of the condition was (please tick one): constant improving deteriorating Impact of the condition on the student s ability to complete the requirements of the relevant unit/s of study: Total incapacitation Where the full impact of the condition was extremely serious in nature and the student was affected to the extent that to complete the requirements of the relevant unit/s of study was not possible (e.g. bedridden, hospitalised). Severe impact Where the full impact of the condition was serious in nature and the student was severely affected. The student could not complete the requirements of the relevant unit/s of study. Moderate impact Where the full impact of the condition was not severe and the student s ability to complete the requirements of the relevant unit/s of study was moderately affected (e.g. a temporary condition which caused some discomfort but did not have a severe impact on the student s ability to complete the requirements of the relevant unit/s of study). Minor impact Where the full impact of the condition was not serious and did not have a significant impact on the student s ability to complete the requirements of the relevant unit/s of study. No impact Where the condition did not have an impact on the student s ability to complete the requirements of the relevant unit/s of study. Unable to assess The full impact of the condition was not able to be determined (e.g. the condition could not be diagnosed; there was no visible/prevalent condition). Tick From To If the stamp does not contain all of the following information, please complete as appropriate: Medical/health practitioner s name: Medical/health practitioner s registration number: Address of practice: Telephone no: Medical/health practitioner s stamp Signature of medical/health practitioner: Owner: Assessment Support Application for remission (removal) of debt in special circumstances 0313 Page 4 of 5

Name of applicant: Privacy statement Personal information collected on this form or supplied by you to RMIT will be treated in accordance with the Information Privacy Act 2000 (Vic) and any related legislation. The information collected on this form is used for the purpose of assisting RMIT to make an informed decision on your application. If changes are required to the amount that you owe the Commonwealth under a HECS-HELP or FEE-HELP scheme, the Australian Taxation Office will be provided with the necessary details to enable it to make the required changes to your debt. Some information on this form may also be provided to the Department of Education, Employment and Workplace Relations (DEEWR) and the Department of Industry, Innovation, Science, Research and Tertiary Education (DIISRTE) when further information about your application is required from them or when amendments are made to your FEE-HELP balance. These latter agencies will treat your information in accordance with relevant Commonwealth privacy legislation. Section D student declaration I wish to apply for remission and/or re-credit of my FEE-HELP or VET FEE-HELP balance, or HECS-HELP debt. I declare that the information I have provided on this application form is accurate and that I have read and understood the information provided with this application form. I understand that I may be liable to prosecution if I knowingly make any false or misleading statements. I give consent for the University to contact my treating practitioner and/or other person or organisation named in supporting documentation to confirm/clarify the information provided and for the practitioner or other person/organisation to provide information limited to its impact on my ability to complete the requirements of the unit/s of study indicated in my application for remission of debt. I understand I may be asked to provide a more specific consent to disclosure of the information should this be required by the University. I also give consent for the University to access supporting documentation that was attached to any application for special consideration or equitable assessment arrangement and has relevance to the period of study under application. I understand that it is my responsibility to establish sufficient grounds for HESA remission and to provide the evidence to support these grounds. I acknowledge that RMIT University reserves the right to confirm the information provided and may vary or reverse any decision regarding my application for remission of debt on the basis of incorrect or incomplete information. Checklist I have read and understood the information contained in Part 1 Information and instructions. I have completed Sections A, B and C of this form including the statement of my special circumstances. I have attached independent supporting documentation substantiating my claim for special circumstances. I have not previously initiated and submitted an application for remission (removal) of debt in special circumstances for the same course/s and period of study. I have read and signed the declaration in Section D. Signature of student: Office use only Date stamp Owner: Assessment Support Application for remission (removal) of debt in special circumstances 0313 Page 5 of 5