{"id":14387,"date":"2022-10-06T16:00:03","date_gmt":"2022-10-06T05:00:03","guid":{"rendered":"https:\/\/enrolments.its.edu.au\/?p=14387"},"modified":"2022-10-06T16:00:07","modified_gmt":"2022-10-06T05:00:07","slug":"student-deferral-or-withdrawal-application-form","status":"publish","type":"post","link":"https:\/\/enrolments.its.edu.au\/?p=14387","title":{"rendered":"Student Deferral or Withdrawal Application Form"},"content":{"rendered":"[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;TITLE&#8221; _builder_version=&#8221;4.18.0&#8243; background_color=&#8221;#8300E9&#8243; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_stops=&#8221;#00c3ef 0%|#000dc9 100%&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_row admin_label=&#8221;TITLE&#8221; _builder_version=&#8221;4.18.0&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; width=&#8221;auto&#8221; max_width=&#8221;1500px&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_text admin_label=&#8221;TITLE&#8221; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221; sticky_enabled=&#8221;0&#8243;]\n<h1 class=\"entry-title\" style=\"text-align: center;\"><span style=\"font-family: verdana, geneva, sans-serif; color: #ffffff;\">Student Deferral or Withdrawal Application Form<\/span><\/h1>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;BODY&#8221; _builder_version=&#8221;4.18.0&#8243; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_row admin_label=&#8221;BODY&#8221; _builder_version=&#8221;4.18.0&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; width=&#8221;auto&#8221; max_width=&#8221;1500px&#8221; collapsed=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221; theme_builder_area=&#8221;post_content&#8221;][et_pb_text admin_label=&#8221;BODY&#8221; _builder_version=&#8221;4.18.0&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FFFFFF&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; 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id='gform_1613'  action='\/index.php?rest_route=%2Fwp%2Fv2%2Fposts%2F14387#gf_1613' data-formid='1613' novalidate>\n        <div id='gf_progressbar_wrapper_1613' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1613_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_1613' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1613_25\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_25'>Instagram<\/label><div class='ginput_container'><input name='input_25' id='input_1613_25' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1613_25'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_1613_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What would you like to do today?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1613_5'>\n\t\t\t<div class='gchoice gchoice_1613_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Defer my course (maximum six months allowed)' checked='checked' id='choice_1613_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1613_5_0' id='label_1613_5_0' class='gform-field-label gform-field-label--type-inline'>Defer my course (maximum six months allowed)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1613_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Withdraw from my course (fees and charges will apply)'  id='choice_1613_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1613_5_1' id='label_1613_5_1' class='gform-field-label gform-field-label--type-inline'>Withdraw from my course (fees and charges will apply)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1613_24\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><P>\n<P><\/div><div id=\"field_1613_6\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2><span style=\"font-family: verdana, geneva, sans-serif;\">DEFERRING FROM A COURSE<\/span><\/h2>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Before you apply to defer from your course, we strongly recommend that you discuss the matter with your course coordinator. Depending on your deferral date, you may still be liable for fees related to any non-completed components of your units or for any outstanding and overdue invoices.<\/span>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">You cannot defer from your course to avoid the Centrelink or Government requirement to 'Show Cause' for unsatisfactory academic progress in a given academic year. Students may only defer from an accredited course for a maximum period of six months. <\/span>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">NOTES: <\/span>\n<p>\n<ul>\n \t<li><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">If you are within your deferral period and your course code or criteria is updated or changed by <a href=\"http:\/\/www.training.gov.au\" target=\"_blank\" rel=\"noopener\">www.training.gov.au<\/a> you may be required to pay additional course enrolment fees so that you can be enrolled in the newest or current version of your course. This will be discussed with you prior to any cut-off dates or deadlines.\u00a0<\/span><\/li>\n \t<li><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Deferral or withdrawal of enrolments will be accepted only if they are made in writing via this form, and signed by the enrolled student.<\/span><\/li>\n<\/ul>\n&nbsp;<\/div><div id=\"field_1613_7\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2><span style=\"font-family: verdana, geneva, sans-serif;\">WITHDRAWING FROM A COURSE<\/span><\/h2>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Before withdrawing from your course, we strongly recommend that you discuss the matter with your course coordinator. Course withdrawals (cancellations) will make you liable for any remaining or outstanding fees related to your course, including any non-completed units. Please refer to our enrolment terms and conditions, specifically our cancellation and refund policies. (<a href=\"https:\/\/www.its.vic.edu.au\/enrolment-terms\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.its.vic.edu.au\/enrolment-terms\/<\/a>)<\/span>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">You cannot withdraw from your course to avoid the Centrelink or Government requirement to 'Show Cause' for unsatisfactory academic progress in a given academic year. Students may only defer from an accredited course for a maximum period of six months. <\/span>\n<p>\n<strong><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">NOTES<\/span><\/strong>\n<p>\n<ul>\n \t<li><strong><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Withdrawing from a course will result in your <span style=\"text-decoration: underline;\">entire course fees<\/span> becoming due immediately.<\/span><\/strong><\/li>\n \t<li><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Deferral or withdrawal of enrolments will be accepted only if they are made in writing via this form, and signed by the enrolled student.<\/span><strong><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">\u00a0<\/span><\/strong><\/li>\n<\/ul><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1613_20' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1613_2' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1613_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1613_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_1613_8'><hr \/>\n<h2><span style=\"font-family: verdana, geneva, sans-serif;\">CONTACT DETAILS<\/span><\/h2><\/div><\/div><div id=\"field_1613_9\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_9'>Please enter your student number (example: ITS2000456)<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1613_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1613_10\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please enter your full name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1613_10'>\n                            \n                            <span id='input_1613_10_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.3' id='input_1613_10_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1613_10_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_1613_10_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.4' id='input_1613_10_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_1613_10_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_1613_10_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.6' id='input_1613_10_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1613_10_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1613_11\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_11'>Please enter your mobile number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_1613_11' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1613_12\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please enter your email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1613_12_container'>\n                                <span id='input_1613_12_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_12' id='input_1613_12' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1613_12' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_1613_12_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_12_2' id='input_1613_12_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1613_12_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1613_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1613_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1613_3' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1613_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1613_13\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_1613_13'><hr \/>\n<h2><span style=\"font-family: verdana, geneva, sans-serif;\">ENROLLED COURSE DETAILS<\/span><\/h2><\/div><\/div><div id=\"field_1613_14\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_14'>Please let us what course you are deferring<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1613_14' type='text' value='' class='large'  aria-describedby=\"gfield_description_1613_14\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1613_14'>Leave this section blank if you are only enrolled in one course with us<\/div><\/div><div id=\"field_1613_15\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_15'>Please enter your class code<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_1613_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1613_16\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_16'>Please state the reason for this request: (Provide as much detail as possible)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_1613_16' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1613_22' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1613_22' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1613_4' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1613_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1613_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is this request being made on compassionate grounds?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1613_17'>\n\t\t\t<div class='gchoice gchoice_1613_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='NO' checked='checked' id='choice_1613_17_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1613_17\"   \/>\n\t\t\t\t\t<label for='choice_1613_17_0' id='label_1613_17_0' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1613_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='YES - (Evidence Required)'  id='choice_1613_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1613_17_1' id='label_1613_17_1' class='gform-field-label gform-field-label--type-inline'>YES - (Evidence Required)<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1613_17'>Compassionate grounds include needing money to pay for: medical treatment and medical transport for you or your dependant. Making a payment on a home loan or council rates so you don't lose your home (final notices). Modifying your home or vehicle to accommodate your or your dependant's severe disability. The loss of a family member etc...<\/div><\/fieldset><div id=\"field_1613_18\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1613_18'>Please upload your evidence for applying on compassionate grounds<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1613_18' 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name='gform_ajax_frame_1613' id='gform_ajax_frame_1613' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n\t\t                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 1613, 'https:\/\/enrolments.its.edu.au\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery('#gform_ajax_frame_1613').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1613');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1613').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){form_content.find('form').css('opacity', 0);jQuery('#gform_wrapper_1613').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1613').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1613').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_1613').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_1613').val();gformInitSpinner( 1613, 'https:\/\/enrolments.its.edu.au\/wp-content\/plugins\/gravityforms\/images\/spinner.svg', true );jQuery(document).trigger('gform_page_loaded', [1613, current_page]);window['gf_submitting_1613'] = false;}else if(!is_redirect){var confirmation_content = 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*\/\n<\/script>\n\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]\n","protected":false},"excerpt":{"rendered":"<p>Student Deferral or Withdrawal Application Form\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_1613' style='display:none'><div id='gf_1613' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1613' id='gform_1613'  action='\/index.php?rest_route=%2Fwp%2Fv2%2Fposts%2F14387#gf_1613' data-formid='1613' novalidate>\n        <div id='gf_progressbar_wrapper_1613' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_1613_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_1613' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1613_25\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_25'>URL<\/label><div class='ginput_container'><input name='input_25' id='input_1613_25' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1613_25'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_1613_5\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >What would you like to do today?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1613_5'>\n\t\t\t<div class='gchoice gchoice_1613_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Defer my course (maximum six months allowed)' checked='checked' id='choice_1613_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1613_5_0' id='label_1613_5_0' class='gform-field-label gform-field-label--type-inline'>Defer my course (maximum six months allowed)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1613_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Withdraw from my course (fees and charges will apply)'  id='choice_1613_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1613_5_1' id='label_1613_5_1' class='gform-field-label gform-field-label--type-inline'>Withdraw from my course (fees and charges will apply)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1613_24\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><P>\n<P><\/div><div id=\"field_1613_6\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2><span style=\"font-family: verdana, geneva, sans-serif;\">DEFERRING FROM A COURSE<\/span><\/h2>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Before you apply to defer from your course, we strongly recommend that you discuss the matter with your course coordinator. Depending on your deferral date, you may still be liable for fees related to any non-completed components of your units or for any outstanding and overdue invoices.<\/span>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">You cannot defer from your course to avoid the Centrelink or Government requirement to 'Show Cause' for unsatisfactory academic progress in a given academic year. Students may only defer from an accredited course for a maximum period of six months. <\/span>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">NOTES: <\/span>\n<p>\n<ul>\n \t<li><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">If you are within your deferral period and your course code or criteria is updated or changed by <a href=\"http:\/\/www.training.gov.au\" target=\"_blank\" rel=\"noopener\">www.training.gov.au<\/a> you may be required to pay additional course enrolment fees so that you can be enrolled in the newest or current version of your course. This will be discussed with you prior to any cut-off dates or deadlines.\u00a0<\/span><\/li>\n \t<li><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Deferral or withdrawal of enrolments will be accepted only if they are made in writing via this form, and signed by the enrolled student.<\/span><\/li>\n<\/ul>\n&nbsp;<\/div><div id=\"field_1613_7\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2><span style=\"font-family: verdana, geneva, sans-serif;\">WITHDRAWING FROM A COURSE<\/span><\/h2>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Before withdrawing from your course, we strongly recommend that you discuss the matter with your course coordinator. Course withdrawals (cancellations) will make you liable for any remaining or outstanding fees related to your course, including any non-completed units. Please refer to our enrolment terms and conditions, specifically our cancellation and refund policies. (<a href=\"https:\/\/www.its.vic.edu.au\/enrolment-terms\/\" target=\"_blank\" rel=\"noopener\">https:\/\/www.its.vic.edu.au\/enrolment-terms\/<\/a>)<\/span>\n<p>\n<span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">You cannot withdraw from your course to avoid the Centrelink or Government requirement to 'Show Cause' for unsatisfactory academic progress in a given academic year. Students may only defer from an accredited course for a maximum period of six months. <\/span>\n<p>\n<strong><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">NOTES<\/span><\/strong>\n<p>\n<ul>\n \t<li><strong><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Withdrawing from a course will result in your <span style=\"text-decoration: underline;\">entire course fees<\/span> becoming due immediately.<\/span><\/strong><\/li>\n \t<li><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">Deferral or withdrawal of enrolments will be accepted only if they are made in writing via this form, and signed by the enrolled student.<\/span><strong><span style=\"font-family: verdana, geneva, sans-serif; font-size: 12pt;\">\u00a0<\/span><\/strong><\/li>\n<\/ul><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_1613_20' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1613_2' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1613_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1613_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_1613_8'><hr \/>\n<h2><span style=\"font-family: verdana, geneva, sans-serif;\">CONTACT DETAILS<\/span><\/h2><\/div><\/div><div id=\"field_1613_9\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_9'>Please enter your student number (example: ITS2000456)<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1613_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1613_10\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please enter your full name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_1613_10'>\n                            \n                            <span id='input_1613_10_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.3' id='input_1613_10_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1613_10_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            <span id='input_1613_10_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.4' id='input_1613_10_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_1613_10_4' class='gform-field-label gform-field-label--type-sub '>Middle<\/label>\n                                                <\/span>\n                            <span id='input_1613_10_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_10.6' id='input_1613_10_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1613_10_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1613_11\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_11'>Please enter your mobile number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_11' id='input_1613_11' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_1613_12\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please enter your email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_1613_12_container'>\n                                <span id='input_1613_12_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_12' id='input_1613_12' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1613_12' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_1613_12_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_12_2' id='input_1613_12_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_1613_12_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1613_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1613_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1613_3' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1613_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1613_13\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><div class='gsection_description' id='gfield_description_1613_13'><hr \/>\n<h2><span style=\"font-family: verdana, geneva, sans-serif;\">ENROLLED COURSE DETAILS<\/span><\/h2><\/div><\/div><div id=\"field_1613_14\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_14'>Please let us what course you are deferring<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1613_14' type='text' value='' class='large'  aria-describedby=\"gfield_description_1613_14\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1613_14'>Leave this section blank if you are only enrolled in one course with us<\/div><\/div><div id=\"field_1613_15\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_15'>Please enter your class code<\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_1613_15' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1613_16\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_16'>Please state the reason for this request: (Provide as much detail as possible)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_16' id='input_1613_16' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_1613_22' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_1613_22' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_1613_4' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_1613_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_1613_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is this request being made on compassionate grounds?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1613_17'>\n\t\t\t<div class='gchoice gchoice_1613_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='NO' checked='checked' id='choice_1613_17_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_1613_17\"   \/>\n\t\t\t\t\t<label for='choice_1613_17_0' id='label_1613_17_0' class='gform-field-label gform-field-label--type-inline'>NO<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1613_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='YES - (Evidence Required)'  id='choice_1613_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1613_17_1' id='label_1613_17_1' class='gform-field-label gform-field-label--type-inline'>YES - (Evidence Required)<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_1613_17'>Compassionate grounds include needing money to pay for: medical treatment and medical transport for you or your dependant. Making a payment on a home loan or council rates so you don't lose your home (final notices). Modifying your home or vehicle to accommodate your or your dependant's severe disability. The loss of a family member etc...<\/div><\/fieldset><div id=\"field_1613_18\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1613_18'>Please upload your evidence for applying on compassionate grounds<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1613_18' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1613_18&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1613_18&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1613_18&quot;,&quot;filelist&quot;:&quot;gform_preview_1613_18&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/enrolments.its.edu.au\\\/?gf_page=8648fed2d8b7155&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/enrolments.its.edu.au\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/enrolments.its.edu.au\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;67108864b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1613,&quot;field_id&quot;:18,&quot;_gform_file_upload_nonce_1613_18&quot;:&quot;3ed7cfe2b5&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;3&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_1613_18&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1613_18' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1613_18' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1613_18\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1613_18'>Max. file size: 64 MB, Max. files: 3.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1613_18'><\/ul> <div id='gform_preview_1613_18' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_1613_23\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_1613_19\" class=\"gfield gfield--type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1613_19'>Student Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><input type='hidden' value='' name='input_19' id='input_1613_19_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_1613_19_Container' class='gfield_signature_container ginput_container' style='height:180px; width:600px; ' ><canvas id='input_1613_19' width='600' height='180' style='border-style: Dashed; border-width: 2px; border-color: #DDDDDD; background-color:#FFFFFF; cursor: url(https:\/\/enrolments.its.edu.au\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;'><\/canvas><\/div><div id='input_1613_19_toolbar' style='margin:5px 0;position:relative;height:20px;width:600px;max-width:100%;'><img id = 'input_1613_19_resetbutton' src='data:image\/png;base64,iVBORw0KGgoAAAANSUhEUgAAABgAAAAYCAYAAADgdz34AAAAGXRFWHRTb2Z0d2FyZQBBZG9iZSBJbWFnZVJlYWR5ccllPAAAAtRJREFUeNrsld9rklEYx32nc7i2GulGtZg6XJbJyBeJzbGZJJVuAyFD7D8QumiG7nLXQuw6dtHN7oYwFtIgDG+2CGQtGf1grBpWIkPHaDpJZvZ95F2cqfPHRTfRgY\/H85znfb7nPc85z8sVi0XR32zcf4GmBTiOk8GWY8YSdEpwHpwG7eAA\/ABJsA3\/w5MEJOUGi8VyCUFFeCiGvlcsFvOFQqGtzK1d4Bzmr8DvDfy\/NyTgcDj6I5GIGA91YdiN4CW7RqNp83g8fZ2dna17e3v5ubm5r1tbWz8F8WH4v4PIh7oCTOumH4VCIQkGg6axsTElgkRhyoJTXq\/33srKStzpdL5KpVK0RVcxvw+Rb40KlNr09LTSbDZH8HcJ\/DqyY2sksE9Go1GHVqsN5fP5Yk9Pz3WIJNmctNQT8Pl8n\/DQZza40CjIokqlerywsMCTYWdnpwVjTb0kF1dXVy2sLR6Pn4HIJnu6mLZht9s3KUeUE7VarYPt459ZOqZlKMFEFRRVfI+QzMzMeBHOOTAw4GbnKt4AK6Vte0\/nHA6pBu\/T4ejoqAgnS4dTlT82U74aJOourYTn+ds1VlyNm+AReMjaK5LsdrvpxoqSyWSX8DbVSwDHtYJ+hi9gETxl\/SoCWK1WGfWJRKLQ0dGhO0kAq5MGAoFB\/OVZXC6XtqYAzvamwWCgMiDK5XKXsSL5CRpZv98vnp+fH2SNJpPpYk0BlIIXSJaB\/lOZkEqlNyCi4ahAHd8iajGUj41a2a+2xzmj0fgsFAoN0QA3lAJfAxMISDeVpx7jSbJnMplSOZ6amuptVIBaZHx8\/G0sFruj1+tlgo2KWh\/oF3opGWl+bW3t1uzsrHJ5eXm42Q+OGW\/wADc7gYe3w+Fwen19\/YByhMMgt9lsqpGRkQvYxifwfQnup9PprFwuX2rmi0ZvYAdDwurPgl1A9ek1eE7byqYR7P873+TfAgwATQiKdubVli0AAAAASUVORK5CYII=' style='cursor:pointer;float:right;height:24px;width:24px;border:0px solid transparent' alt='Clear Signature' \/ ><\/div><input type='hidden' id='input_1613_19_data' name='input_1613_19_data' value=''><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_1613' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_1613' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <input type='hidden' name='gform_ajax' value='form_id=1613&amp;title=&amp;description=&amp;tabindex=0&amp;theme=gravity-theme&amp;styles=[]&amp;hash=1df98a5b7c805dc66e7ea39c3fc98767' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_1613' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_1613' id='gform_theme_1613' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_1613' id='gform_style_settings_1613' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_1613' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='1613' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='AUD' value='+F1qAhsxUD2r8vuft3P1g5GabKyG1egF1zyl15b0VZq27+uta7pI2BKNwMdnquEEaQgMk68qKO1Dlh+MDvJj9OM+Zd+2H7dWUfeNUDJ4AvFTZIM=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_1613' 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