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STATEMENT OF REASONS

Breach of Minimum Academic Standards

1. PERSONAL DETAILS
Date of birth:_______ /_______ /_______ (dd/mm/YYYY)

Student number:
Campus enrolled:
Title: Dr

 Townsville

Mr

 Cairns

Mrs Ms Miss

 Brisbane
Other: ________

 Singapore

 Other______________________________

Family name: ______________________________________________

Given name/s: _______________________________________________ Phone number: ________________________________________
PLEASE NOTE: Notification of the outcome of your Statement of Reasons will be mailed to your preferred address within 3 weeks of the due date. Address changes can be made via eStudent or by submitting a Change of Personal Details form
(http://www.jcu.edu.au/studying/entry/forms.html).

2. ENROLMENT DETAILS
I have been advised to submit a Statement of Reasons for the course: _____________________________________________________
(e.g. Bachelor of Arts, Bachelor of Social Work etc)

Please tick which of the statements below best summarise your situation: r I intend to continue in my current course

r

I intend to withdraw (or have already withdrawn) from my current course

r

I intend to take a leave of absence from my current course

r

I intend to apply (or have already applied) to change my course to ____________________________________________________

3. STATEMENT OF REASONS
Attach a statement, preferably no longer than a page, to this form, explaining in your own words:
•

Why you believe you failed the subjects

•

How your circumstances have now changed, and

•

Why you believe you will be able to pass your subjects if allowed to re-enrol.

You must make sure that your statement is signed and dated and securely attach any supporting documentary evidence (medical/ counsellor certificates etc).

4. RETURN FORM
The completed form and Statement of Reasons must be returned by the due date shown on the letter of