International Application for Enrolment

Last name (Family/Surname) *

First name(s) (Given names) *

Preferred name

Date of Birth *

Email Address *

Passport / Citizenship details

Your nationality *

Passport Number *

Country of Issue *

Passport expiry date *

What ethnic group(s) do you belong to? (You may tick up to three boxes that apply to you)

Please specify if “Other Pacific Peoples”, “Other European”, “Other Southeast Asian”, “Other Asian” or “Other”.

Programme Name *

Location *

Dates *

Home Address *

Telephone Number *

Please include your country and area code

Postal Address in New Zealand (if known)

Agents Name

Agents Company Name

Agents Address

Country

Telephone number

Country Code - Area Code - Number

Mobile number

Country Code - Area Code - Number

Their email address

Prior Activity

What will be/was your MAIN activity or occupation in New Zealand at 1 October in the year before commencing study at Tai Poutini Polytechnic, a business division of Te Pūkenga? Tick only one box.

This information regarding your education background is required by the New Zealand Ministry of Education

Secondary Education

What was the name of the last or present secondary school you attended? State “Overseas” if applicable. *

When was your last year of secondary school? *

Your highest achievement may be a “traditional” award such as School Certificate, or you may have achieved a number of credits or a National Certificate in a certain level on the National Qualifications Framework. Your NZQA Record of Achievement shows how many credits you have.

First Year of Tertiary Study

Will this be the first year you have enrolled in a Polytechnic, University, Private Training Establishment, or Wananga either in New Zealand or overseas since leaving school? Do not include enrolments in STAR, TOPS, community hobby classes.

Yes

No

If you answer ‘No’, please enter the year of your first enrolment below

You must provide evidence of English language competence. The International Language Testing System (IELTS) is the preferred test, although scores from the Test of English as a Foreign Language (TOEFL) will be considered.

What is your first language? *

What other languages do you speak?

Have any of your previous studies been completed in English?

Yes

No

If you answered ‘Yes’ please provide details

Name of English Language test *

Score *

Year taken *

This information is used to enable us to provide support and for statistical purposes. The information you supply is confidential.

Do you live with the effects of injury, long term illness or disability?

Yes

No

If ‘Yes’, please describe your injury, longterm illness or disability in general terms.

Is there any special support you would need to study or complete this programme?

Yes

No

If ‘Yes’, please specify (eg, literacy, numeracy, hearing, visual)

Contact person in case of emergency

Name *

Address (a post box is unacceptable) *

Mobile Phone Number *

Home Phone Number

Work Phone Number

Relationship to you *

If you are flying into Hokitika, do you require a pick-up from the airport?

Yes

No

Do you need us to find you accommodation?

Yes

No

How did you hear about the programme you are applying for? Please tick any relevant boxes.

Other (please specify)

Note: The non-declaration of an offence that you are required to disclose will be seen as a misrepresentation of a criminal record. This may result in your application for enrolment being declined. Please ensure that you detail convictions that are required to be disclosed.

Have you ever been convicted of any offence against the law (apart from minor traffic convictions)?

Yes

No

If YES, please specify details with the date of conviction:

PRIVACY

Tai Poutini Polytechnic, a business division of Te Pūkenga, collects and stores information from this form to comply with the requirements of the Ministry of Education (student statistical returns), New Zealand Qualifications Authority (Unit Standard outcomes), Tertiary Education Commission (funding returns), Industry Training Organisations (funding and academic outcomes), Ministry of Social Development (confirmation of enrolment and academic outcomes), Inland Revenue Department (student loan interest rebate), Department of Immigration (if you are not a New Zealand citizen or permanent resident) and Agencies who support particular students through scholarships and prizes, payment of fees or other awards (if you are not a recipient of one of these awards). The information is also used to select students for qualifications, to manage internal administrative processes, and for internal reporting. Information about students may be supplied to, and sought from, other educational organisations for the purpose of verifying academic records.

In addition, when required by statute, the Institute releases information to Government agencies such as the New Zealand Police, Ministry of Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC).

In signing this enrolment form you authorise such disclosure on the understanding that TPP will observe the general conditions governing the release of information, as set out in the Privacy Act 2020 and the Post-compulsory Unique Identifier Code of Practice. You may view information held about you and amend any errors in that information. To do so, contact the TPP Registry.

NB: The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires the Organisation to collect, hold, handle, use and disclose personal information in accordance with the twelve information principles in the Act. http://www.privacy.org.nz/privacy-act

NATIONAL STUDENT INDEX

Please note that your name, date of birth and residency as entered on this enrolment will be included in the National Student Index, and will be used in an Authorised Information Matching programme with the New Zealand Birth Register. For further information please see http://www.nsi.govt.nz/ima

WITHDRAWAL AND REFUND INFORMATION

You must notify us of your withdrawal in writing.

Withdrawal prior to programme start date – full refund tuition fee refund.
Withdrawal within the first 7 calendar days of the programme – 80% tuition fee refund.
Withdrawal after the 7th calendar day of the programme – no refund.
A case for compassionate consideration for a refund can be made to the Director.

CODE OF PRACTICE

Tai Poutini Polytechnic has agreed to observe and be bound by the Education (Pastoral Care of Tertiary and International Learners) Code of Practice 2021. Copies of the Code are available on request, or further information can be found on the New Zealand Qualifications Authority website (http://www.nzqa.govt.nz).

STUDENT HANDBOOK

On enrolment, each student will receive a student handbook. The student handbook provides information on formal procedures and policies of Tai Poutini Polytechnic as they apply to students.

MEDICAL AND TRAVEL INSURANCE

The New Zealand Ministry of Education, through the Code of Practice for the Pastoral Care of International Students, requires that all international students must have the appropriate medical and travel insurance for the duration of their study in New Zealand. Tai Poutini Polytechnic can provide details of their preferred supplier.

Application Checklist - Have you included:

Photocopy of your passport

Completed Enrolment Form

Certified copy of IELTS

Certified copies of your academic records, CV (resume), statement of purpose

Any other additional information

Student Declaration

Please check the following

I hereby declare the information given to be true. I authorise any information given to be used in compliance with the Privacy Act. I acknowledge that I am bound by the statutes, regulations and policies of Tai Poutini Polytechnic. I also understand that

I agree that if there are concerns regarding my welfare, safety or behaviour, that after discussing them with me, the Tai Poutini Polytechnic Student advisor can contact my parents, guardians or educational agent to discuss appropriate causes of action.

I have read and understood the International student fees, charges and refund conditions.

I understand that the making of a ‘false declaration’ is an offence under the Crimes Act 1961.

Signature *

Date *

Disclaimer

Tai Poutini Polytechnic a business division of Te Pūkenga – New Zealand Institute of Skills and Technology, reserves the right to cancel programmes/courses where enrolment numbers are insufficient to make delivery financially viable.

In that event, the Polytechnic accepts no liability for personal expenses incurred by potential students. Any fees paid in this situation will be refunded in full.

From 2023, Tai Poutini Polytechnic Ltd and the programme you have enrolled in will become part of Te Pūkenga – New Zealand Institute of Skills and Technology. All programmes offered by Tai Poutini Polytechnic Ltd and other subsidiaries of Te Pūkenga are under review, to ensure they are portable, consistent and aligned with the needs of industry. The programme you have enrolled in may change over time.

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International Application for Enrolment

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