SRAF 2015
Griffith College Dublin
STUDENT RECORD AMENDMENT FORM 2014
This form should be completed by the student and signed by the Head of Faculty
STUDENT PERSONAL DETAILS
(This section must be completed in all cases)
Student Number: Study Mode: Full-time Part-time
Surname: ____________________________ Forenames: _____________________________
Home Address: _________________________________________________________________
Faculty: __________________________
Year ____________ Course Code: __________________________
TYPE OF AMENDMENT
(To be completed by the Student and the Academic Faculty irrespective of the request or the changes indicated)
A. Notification of Withdrawal B. Change of Course
C. Notification of Leave of Absence D. Subject Deferral
/ Course Deferral
E. Application for Exemption F. Change of Modules
G. Change of Personal Details H. Other
I certify that the information included on this form is accurate and complete to the best of my knowledge. I accept responsibility for payment of all fees in connection with changes made in this form.
Student’s Signature: ____________________________ Date: ____________
Course Administrator’s Signature: _________________ Date: ____________
I do / do not consent to the amendment requested by the student in this form.
Head of Faculty’s Signature: ______________________ Date: ____________
SECTION A: NOTIFICATION OF WITHDRAWAL FROM A COURSE
Each student should submit a formal letter of withdrawal to the Course Director stating the last date of attendance. This letter will be retained by the Faculty Office and a copy attached to this form. The student's ID card must be attached to the Student Record Amendment Form.
Last date of Attendance: ______________________ Verified by Course Administrator ___________
Reason for Withdrawal (Please tick)
A - Transferred to another Institution B - Health Reasons
C - Financial
STUDENT RECORD AMENDMENT FORM 2014
This form should be completed by the student and signed by the Head of Faculty
STUDENT PERSONAL DETAILS
(This section must be completed in all cases)
Student Number: Study Mode: Full-time Part-time
Surname: ____________________________ Forenames: _____________________________
Home Address: _________________________________________________________________
Faculty: __________________________
Year ____________ Course Code: __________________________
TYPE OF AMENDMENT
(To be completed by the Student and the Academic Faculty irrespective of the request or the changes indicated)
A. Notification of Withdrawal B. Change of Course
C. Notification of Leave of Absence D. Subject Deferral
/ Course Deferral
E. Application for Exemption F. Change of Modules
G. Change of Personal Details H. Other
I certify that the information included on this form is accurate and complete to the best of my knowledge. I accept responsibility for payment of all fees in connection with changes made in this form.
Student’s Signature: ____________________________ Date: ____________
Course Administrator’s Signature: _________________ Date: ____________
I do / do not consent to the amendment requested by the student in this form.
Head of Faculty’s Signature: ______________________ Date: ____________
SECTION A: NOTIFICATION OF WITHDRAWAL FROM A COURSE
Each student should submit a formal letter of withdrawal to the Course Director stating the last date of attendance. This letter will be retained by the Faculty Office and a copy attached to this form. The student's ID card must be attached to the Student Record Amendment Form.
Last date of Attendance: ______________________ Verified by Course Administrator ___________
Reason for Withdrawal (Please tick)
A - Transferred to another Institution B - Health Reasons
C - Financial