MDX Interruption Form

Interruption Form

MIDDLESEX UNIVERSITY DUBAI
MISIS No.*
M0XXXXXXX
Full Name *
Programme of Study
Programme_Form*
This is filled with auto-fill
Programme
Programme Coordinator's Email*
This is filled with auto-fill
Personal E mail ID*
example@example.com
Year of Study*

Year 1Year 2Year 3
Mode of Study*

Full TimePart Time
International/Local Contact No.*
Expected Return
ProgrammeYear
ProgYear
Expected Return_1*
Expected Return_2*
Expected Return_3*
REASON FOR INTERRUPTION: (PLEASE TICK)*

Content of ProgrammeTravel IssuesSocial life not what I expectedTeaching experience not what I expectedUniversity life/Learning experience not what I expectedLanguage DifficultiesFinancial DifficultiesHomesickTransfer to another institutionAcademic DifficutiesFamily/Personal obligationsInsufficient support from employerChange of employment status/found employmentOther
Do you have any outstanding reassessment(s)/resit or deferred assessment(s)?*

YesNo
Do you intend to complete this reassessment(s)/resit or deferred assessment(s) during your interruption period?*

YesNo (If no, then you confirm that any outstanding reassessment(s)/resit or deferred assessment(s) should be deferred until you return)
I confirm that I am aware of the financial Implications of my decision. https://www.mdx.ac.ae/life-at-university/current-students/interruptions-and-withdrawals (or please contact studentfinance@mdx.ac.ae)*

Yes
I confirm that I have discussed my decision with my Campus Programme Coordinator.*

Yes
Student Signature*

Clear
Form Status
Date*

DayMonthYear
Date
Should be Empty: