X:\EMS\Publications\Forms\Master FormProfomas\FRM FeeExtension Application 2013 V3_131001.

docx Version 6 Revised 18022013

PLEASE REFER TO THE BACK OF THIS FORM FOR INSTRUCTIONS AND INFORMATION
A $50 fee is payable by the student each time an extension of time to pay tuition fees is approved


Student ID Number
Family Name ___________________________________ Given/Other Names ________________________________________
Course Name _____________________________________________________________________________________
Contact Phone No. _____________________________________________________________________________________

Have you previously applied for an extension?

Yes No


Please provide full details of the circumstances that prevent you paying by the due date and the steps you are taking to pay by the new
payment date.






Extension up to 2 weeks Nominate preferred date of payment: ____/____/____

Longer extension required exceptional circumstances only. Nominate preferred date of payment: ____/____/____
Supporting documentation MUST be provided for a longer extension to be considered, and you will be contacted to negotiate a
new payment date.


I acknowledge that if my extension application is approved, the $50 extension fee will be charged and payable by the revised payment due date.
If I fail to pay my fees by the revised payment due date I will be liable for a $100 late payment penalty and my enrolment may be cancelled. I also
acknowledge that the cancellation of my enrolment will not cancel any outstanding fee liability with the University of Melbourne and this debt will be
pursued.

Student Signature Date

The University of Melbourne collects personal information in accordance with the University Privacy Policy which can be viewed in full at http://policy.unimelb.edu.au/MPF1104
Information is collected, used and stored for the purpose of administering enrolment and related activities. Commonwealth and State agencies require certain information to be
reported or disclosed by the University. You may request access to your information at any time by contacting the privacy officer at privacy-officer@unimelb.edu.au





TEAR HERE

RECEIPT: FEE EXTENSION APPLICATION

Date lodged: Student Centre Name:
Hard copy fee extension requests may be submitted at you Student Centre or the Baldwin Spencer Building. Digital submissions may be sent to
sa-fees@unimelb.edu.au from your University of Melbourne email account. Your fee extension request can take up to 5 business days to process.
Please direct all enquiries to Fees Student Administration on (03) 8344 4772
Fee Extension Application
- Full Fee Students Only

X:\EMS\Publications\Forms\Master FormProfomas\FRM FeeExtension Application 2013 V3_131001.docx Version 6 Revised
18022013

Request for Fee Statement or
Replacement Commonwealth
Assistance Notice

INSTRUCTIONS TO STUDENTS

1. Complete this form making sure you indicate your preferred payment date. The maximum extension period is up to 2 weeks except in exceptional
circumstances, where a date will be negotiated. Proof of exceptional circumstances will be required.
2. Sign the form where indicated.
3. Lodge the form at your Student Centre or via fax or email to Fees-Student Administration.
4. A $50 fee is payable by the student each time an extension of time to pay tuition fees is approved. No extension of time is possible for Commonwealth
supported students or those on FEE-HELP as the deadlines are set by the Commonwealth."
5. Your fee extension can take up to 5 business days to be processed.
6. You will be notified of the outcome of your application via email to your University email account.
7. Please make sure you make your payments by the new due date in order to avoid a $100 late payment penalty.

PENALTIES FOR NON-PAYMENT OF FEES
Non-payment of fees may incur the following penalties:

$100 late payment fee Prohibited from graduation
Cancellation of enrolment Prohibited from conferral of award
Withdrawal from subjects Withholding of results

MORE INFORMATION
If you are experiencing financial difficulty, you may wish to contact Student Financial Aid regarding any assistance that may be available to you.
Contact details and self-help information Is available on the web at www.portal.unimelb.edu.au
Log in to the portal at any time to check your fees.
Information about the fee policy is available at http://www.futurestudents.unimelb.edu.au/admissions/fees

INSTRUCTIONS FOR STUDENT CENTRES
1. Identify the student (e.g. student card, drivers licence)
2. Check the student has signed the form and all fields are completed.
3. Complete Student Centre use fields and date the form.
4. Complete Student receipt section and give to student.
5. Forward the form & any supporting documentation to Fees-Student administration, level 1, Raymond Priestley Building before the fee due date.
6. Advise the student the outcome of their application will be emailed to their University email account.
OFFICE USE ONLY

Student Centre Use Only
Student Centre Name: Date Lodged:
Staff Member Name: No. of pages (inc. application form)
SA-Fees Use Only
Extension Approved? Yes/No Date: Amount Approved $
Comments:
Processed by:




Direct all correspondence to:
Fees - Student Administration
The University of Melbourne VIC 3010
Tel: +613 8344 4772
Fax: +613 9347 2520
Email: sa-fees@unimelb.edu.au