WHITECLIFFE APPLICATION

The purpose of this application form is to obtain the information we need, if you are accepted into a programme at Whitecliffe. We also need to collect information required by the Ministry of Education and other Government agencies for statistical and registration reasons. Complete all sections of the application in full. Incomplete applications will not be processed.

SECTION ONE | PROGRAMME OF STUDY

Programme:*

SECTION TWO | PERSONAL DETAILS

Title
Legal Family Name:*
Legal First Names:*
Previous Name(s) (if applicable)
Preferred Name:
Date of Birth*
Gender*
National Student Index Number (NSN):

Note: Your name, date of birth and residency as entered on this application 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

SECTION THREE |  CONTACT DETAILS

Note: Whitecliffe must be advised of all changes to your contact details as they occur.
International students: Write your full overseas address and contact details clearly in English.

Permanent Home Address

Address*
City:*
Country:*
Post Code:*

Address While Studying

 

Term Address:
Term City:
Term Postal Code:
Phone: +64*
Mobile: +64*
Email*

SECTION FOUR | CITIZENSHIP

To qualify as a domestic student, and so be entitled to the Government tuition subsidy, you must be a citizen of New Zealand (including students from the Cook Islands, Tokelau, or Niue who have New Zealand citizenship) or a permanent resident of New Zealand or a citizen or permanent resident of Australia residing in New Zealand. You must provide evidence of citizenship or permanent residency and to do so you must produce one of the following:

 

* Birth certificate with place of birth stated as New Zealand, Cook Islands, Tokelau, or Niue.

* New Zealand passport.

* A statement of Whakapapa, including date of birth, countersigned by a kaumatua.

* Certificate of citizenship or letter of confirmation.

* Overseas passport with residency stamp.

 

You can bring the original documentation to the enrolment desk, alternatively please provide a certified copy. This means a photocopy of your original document, signed as being a true and accurate copy by a Justice of the Peace (JP), Solicitor, Minister of the Church, General Practitioner or School Principal for example.

International students must bring their passport with them when they enrol.

Which best describes your citizenship or permanent residency. *

SECTION FIVE | ETHNIC IDENTITY

Ethnic Group*
Ethnic Group. If other please specify:

If you identified as New Zealand Maori in the previous question, what is the name of your Iwi? 

IWI
IWI 2
IWI 3

SECTION SIX | PREVIOUS EDUCATION

Name of last secondary school you attended (indicate if overseas)?*
What was your last year of attendance at secondary school?*
What is the highest academic qualification you hold from a secondary school?*
What year did you obtain your highest secondary academic qualification?*
Have you previously enrolled in tertiary education either in New Zealand or overseas?
If yes to tertiary education, enter first year of enrolment

List Institution/s, course/s and year/s of study:

Institution 1 / Course of Study / From - To
Institution 2 / Course of Study / From - To
What tertiary qualification do you hold?

SECTION SEVEN  |  ACTIVITY PRIOR TO ENROLMENT

 

Indicate below your current occupation or main activity.

Current Occupation or Activity*

SECTION EIGHT |  SUPPORT

Note: The Ministry of Education requires this data to be collected.  The information you supply is confidential and will not affect your application.  Extra support is available for students with medical conditions, disabilities and/or learning difficulties.

Do you live with the effects of significant injury, long-term illness or disability?*
Please tell us what type of injury/illness/disability you live with:
Would you like a Pastoral Care Co-ordinator to contact you?
In the event of an emergency will you need help to evacuate the building?

EMERGENCY CONTACT (Compulsory)
In an emergency, whom do you want us to contact?

Emergency Contact: - Name of Person:*
Emergency Contact: - Contact Number:*
Emergency Contact: - Relationship:*

SECTION NINE | STUDY DETAILS

What Year Is Your Enrollment For?
Which Campus Location Do You Want To Study At?*
Programme Category:*
If applying for a student loan and/or Interest Wipe-Out provide your IRD number or contact Inland Revenue directly.

Recognition of Prior Learning / Transfer of Credit

Do you wish to apply for transfer of credit for courses completed at another institute or other recognition? *
Institution 1: Year
Institution 1: Educational Institution
Institution 1: Qualification
Institution 2: Year:
Institution 2:. Qualification
Institution 2: Educational Institution:

Applicants for Arts and Design Programmes at Level 7 and above must complete.

Please write an explanation of the reasons you want to study the programme that you are applying for, and the goals you wish to achieve, in approximately 250 – 500 words. Provide any other details about yourself that support your application.

Please attach with other required documents at the bottom of this page.

 

 

 

If an International Student, if you are currently in New Zealand please indicate:
Expiry date of Student Visa:
Please specify the country of the passport used to enter New Zealand

*If you are represented by an agent have your agent complete Section Eleven International Agents.

SECTION TEN  |  LETTER OF INTENT

If Other (Please Specify) / (State “overseas”, if applicable )
Tertiary qualification - if other please specify:

Complete this section if you have other qualifications or training relevant to the programme you are applying.

1. Year / Qualification or Training / Provider
2. Year / Qualification or Training / Provider
If OTHER (Please specify):
Would you like your Head of Department to be informed?

SECTION 10  |  MARKETING

Indicate how you heard about Whitecliffe.*
Please Specify:
Referrer
Why did you decide to study at Whitecliffe?
Why Whitecliffe? If other (Please specify):

SECTION 11  |  INTERNATIONAL AGENT

I declare that I have personally consulted this student on their application with their approval, and I have sighted and confirmed the accuracy of all attached documentation.

Agency Name
Agent Email
Agent Contact Number

N.B. *Payment of commission is dependant on holding a current Agency Agreement

SECTION 12 |  TUITION FEE

 

 

How will you pay your tuition fee?

NOTE

Tuition Fees are correct at time of publication but can be subject to change. All fees are inclusive of GST and are in New Zealand Dollars. The tuition fees also include the building swipe card and student ID card. (Any replacement cards are to be purchased at the student’s expense)

SECTION 13  |  DECLARATION

Privacy

The Organisation collects and stores information from this form to comply with the requirements of the Ministry of Education (student statistical returns), New Zealand Qualifications Authority (Record of Learning registration and 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 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, Department 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 the Organisation will observe the general conditions governing the release of information, as set out in the Privacy Act 1993 and the Post-compulsory Unique Identifier Code of Practice. You may see any information held about you and amend any errors in that information. To do so, contact the Enrolments Officer.

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 privacy principles in the Act. http://www.privacy.org.nz/privacy-act

 

Fees

In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery. The Organisation’s policy on withdrawal and refund of fees may be obtained from the Enrolments Officer.

 

Rules

In signing this enrolment form you undertake to comply with the published rules and policies of the Organisation with regard to attendance, academic progress, standard of dress, health and safety, and behaviour. 

DOCUMENTS TO ATTACH: CHECKLIST  

Upload Documents*
  
By submitting this form, I agree that Whitecliffe College may call, text and/or email me. Please note, this consent is not required to attend their institutions and you may unsubscribe at any time.
Declaration – I declare that to the best of my knowledge all the information supplied on, and with, this application form is true and complete, I agree to abide by the conditions described above, and I consent to the disclosure of personal information as described above. (If the applicant is under 18 years of age at time of application please have a parent or guardian sign this application).*