Module Opt-Out Request Form 退出课程表格

SECTION 1: STUDENT'S PARTICULARS
1. Name in Full 姓名
2. Class 班级
3. Student ID 学生号
Maximum of 4 digits allowed. Currently Entered: 0 digits.
4. Course Name 课程名称
5. Contact No. 课程名称
Maximum of 8 digits allowed. Currently Entered: 0 digits.
6. Name of Module 退出的科目
7. Reason for Opt Out. 退出的理由。
Minimum of 5 words required. Currently Entered: 0 words.
8. Upload Parent's Letter 提交家长信

Attach Files
9. Declaration 宣言

9. Declaration 宣言 I hereby confirm my intention to seek opt-out from the module stated above. I understand and agree that the request is subject to the approval of the School.
10. Student’s Email 学生邮箱
11. Draw your signature into the box below. 请在此签字。

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
12. Date 日期 12. Date 日期 / MM / DD YYYY
SECTION 2: APPROVED BY

Receipt of Document Submission
Please ensure that for student who is below 18 years old, Parent's/Guardian's Consent Letter must be submitted together with the request form.
Request Is APPROVED / REJECTED
Name
Designation
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date
Remarks
SECTION 3: LETTER OF EFFECT PREPARED BY
Name
Designation
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date
SECTION 4: OUTCOME OF APPEAL (IF REQUEST WAS REJECTED)
Appeal Is APPROVED / REJECTED
Name
Designation
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date
Remarks
SECTION 5: LETTER OF EFFECT PREPARED BY
Name
Designation
Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date

Module Opt-Out Request Form 退出课程表格

Module Opt-Out Request Form 退出课程表格

SECTION 1: STUDENT'S PARTICULARS

SECTION 2: APPROVED BY

SECTION 3: LETTER OF EFFECT PREPARED BY

SECTION 4: OUTCOME OF APPEAL (IF REQUEST WAS REJECTED)

SECTION 5: LETTER OF EFFECT PREPARED BY