Apply for a Course Extension

Information requested on this form is for College purposes. Your privacy will be maintained. All data is confidential and is not forwarded to any third party except for pooled data supplied for regulatory reporting purposes as required. This information assists in quality assurance and in the issuance of qualifications and other awards. Complete this form on line, you can view your submission. It will automatically be prepared for email to us and is secure. Once the form is completed you will automatically be redirected to a payment page where you make your payment for your course extension via Paypal. Contact us if you require help in completing the form

I wish to extend my enrollment in the course (Name and Code):  *


Title  *


First Name  *

Family Name  *

Gender  *


Birthdate mm/dd/yyyy  *

Residential Address

Address  *

Town/ City  *

State/ Region  *

Post Code/ Zip Code  *

Country  *

Email *

Confirm Email address  *

Phone  *

7. The College of Integrative Veterinary Therapies, the College board, teachers, lecturers, tutors or staff will not be held liable in respect of any information, instruction or advice given to any student, ex-student or practitioners, whether directions given at any time or in any situation are followed or not. The courses are given as advice and instruction, and anyone carrying out treatment under these conditions must accept full responsibility for such consultation and or treatment. The College reserves the right to: Make any changes at any time to policy, syllabus, lecturers, tutors, guidelines, schedules, costs, administration fees, seminars/tutorials, clinics etc and any other provision contained in the website, course or module or unit outlines or in any online brochure or information. Cancel, postpone or consolidate any course should there be, in the opinion of the College, insufficient enrolments prior to the commencement of the course. Enrolled students will be notified, and the fees will be put towards a subsequent course or to be refunded. To automatically add student details to the College mail list unless otherwise requested by the student in writing not to do so.

Students are requested to contact the College before submitting/ signing this form if clarification of any point is required .

I have read the Enrolment Terms and Conditions   *


I acknowledge the points made here. I understand that should I defer, that payments for the Course will continue until all payments are completed. I certify that all the details on this form are correct.  By submitting this form, I have in effect signed this form. I wish to go ahead with this application.

By submitting this form I agree to making payment for my course extension through Paypal. I understand that I will re-directed to a payment area when I submit this form and will make my payment using Paypal or credit card.

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