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Kia Ora! Welcome to Unitec Institute of Technology
Application/Enrolment Form 2016
You can save time and paperwork if you apply online at www.unitec.ac.nz.
This form is for new students or current/returning students applying for a new programme.
You should also be a citizen or permanent resident of New Zealand, the Cook Islands, Tokelau, Niue or Australia.
If you have any questions about your application please call us on 0800 10 95 10 or email study@unitec.ac.nz and
one of our advisors will be happy to help.
International students can contact the International Office on +64 9 815 4302 or email international@unitec.ac.nz
for information and assistance.
PERSONAL INFORMATION
Enter details as shown on your birth or marriage certificate or passport. You are required to provide certified
copies of your name, date of birth and residence or citizenship status. Please refer to details on page 2.
Last name
First names
Preferred first name
If you have changed your name (e.g. by marriage or deed poll), please include certified proof.
Previous name(s)
✔ Female
Male Date of birth
Day/Month/Year
Is this your first application to study at Unitec?
✔ Yes
No
Unitec Student ID number (if known)
Name of programme(s) you are applying for in order of preference
1.
2.
3.
4.
Specialisation or major (See www.unitec.ac.nz or programme brochure for details)
Preferred campus.
Mt Albert campus (Carrington Rd, Mt Albert)
Northern campus
(10 Rothwell Ave, Albany)
Waitākere campus
Not sure
Semester 2
Summer School
(Ratanui St, Henderson)
Year and semester you will commence study.
Year
Full-time
Semester 1
Part-time
Email
The email address you provide will be used to create a self-service account for you.
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 1.
Unitec Application/Enrolment Form
ETHNIC GROUP
Tick up to three boxes.
African
Australian
British/Irish
Cambodian
Chinese
Cook Island Maori
Dutch
Fijian
Filipino
German
Greek
Indian
Italian
Japanese
Korean
Latin American
Middle Eastern
NZ European/Pakeha
New Zealand Maori
Niuean
Polish
Samoan
South Slav
Sri Lankan
Tokelauan
Tongan
Vietnamese
Other Pacific Peoples*
Other Southeast Asian*
Other Asian*
Other European*
Other*
*If other, please specify the ethnic group you identify with:
If you have identified as NZ Māori, enter the name of your iwi. (You can enter up to three iwi names). If you do not know what to enter,
contact the Pae Arahi, Hare Paniora (ph +64 9 815 4321 ext 7783 or email hpaniora@unitec.ac.nz), or Maia (ph +64 9 815 4321
ext 8695) for assistance.
Iwi
CITIZENSHIP
To qualify as a domestic student, and to 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. You are required to provide original documentation
or a certified copy of the original document. A certified copy is a photocopy that an authorised person who has
sighted the original documentation has confirmed, dated and signed. An authorised person is a person listed in the
Oaths and Declarations Act 1957 who is able to take declarations. This person could be a Barrister or Solicitor of the
High Court, a Justice of the Peace (listed in the Yellow Pages), a Notary Public, a Court Registrar or Deputy Registrar, a
Member of Parliament, or a Land Transport Safety Authority, Public Trust, or local authority employee designated for
this purpose. If you are in a remote community and are unable to access a person listed in the Oaths and Declarations
Act 1957, a school principal, minister of religion, or general practitioner is acceptable. You may bring original
document/s to Student Central (Te Pae Kōrero) for Unitec staff to make a photocopy of the document/s and verify,
stamp and sign the copy.
Where a birth certificate, passport or certificate of NZ citizenship has been provided and there has been a change
of name since that document was issued, a marriage certificate, dissolution of marriage certificate or statutory
declaration document will also be needed in order to confirm current details.
If you are applying to Unitec for the first time you need to supply proof of citizenship and eligibility to study. Certified
documentation is essential.
Please tick one of the boxes below. In the right hand column next to the box you have ticked, please tick and supply a
certified copy of one of the relevant documents with this application form.
Choose the citizenship or permanent residence status that applies to you.
New Zealand Citizen
New Zealand birth certificate
New Zealand passport
Certificate of NZ citizenship
A statement of Whakapapa stating your full name and date of birth and
countersigned by a kaumatua
Birth certificate with place of birth stated as Cook Islands, Niue or Tokelau
New Zealand Permanent
Resident
Passport with a current residency permit
My country of citizenship is:
Australian Citizen
Australian birth certificate – only if you were born before August 1986
Australian passport
Certificate of Australian citizenship
Australian Permanent
Resident
Passport with a current residency permit
My country of citizenship is:
Refugee status
A document from Immigration New Zealand confirming refugee status. (Should
evidence of New Zealand permanent residence also be required then a passport
with a current residency permit or a letter from Immigration New Zealand confirming
permanent resident status will need to be provided)
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 2.
Unitec Application/Enrolment Form
CONTACT DETAILS
Your preferred address for all Unitec correspondence.
Postal address
Postcode
Phone (0
Town/city
Mobile (
)
Fax (0 )
)
Your address while studying (if different from above).
Street address
Postcode
Town/city
Mobile (
Phone (0
Fax (0
)
)
)
Work/business address (if applicable).
Company name
Postal address
Town/city
Postcode
EMERGENCY CONTACT
Name
Home phone (0
Mobile phone (
)
)
Work phone (0
)
Relationship
STATISTICAL INFORMATION
The Ministry of Education requires this data to be collected before your application can be processed.
Is this the first year you have enrolled in a University, Polytechnic, College of Education, Private Training
Establishment, or Wananga in New Zealand or overseas since leaving school?
Do not include STAR, community or hobby classes.
✔ No
Yes
If you answered “No”, please enter the name of the organisation you studied at and the year of your first enrolment:
Name
Year
What was your main activity in New Zealand in the year before starting this programme/s at Unitec?
(select only one).
Student of a Secondary School
Wage/salary worker
Student of a Polytechnic
Self employed
Student of a University
Unemployed
or other beneficiary
Student of a Wananga
Student of a Private Training Establishment (PTE)
e.g. DPB, Sickness, ACC (excluding retired)
Houseperson/retired
Overseas
Name of Private Training Establishment
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 3.
Unitec Application/Enrolment Form
What is the highest level of achievement you hold from a secondary school? (Select only one).
This may be a “traditional” award such as School Certificate, a number of credits, or a National Certificate at a certain level on the
National Qualifications Framework. Your NZQA Record of Learning shows you how many credits you have.
No formal secondary qualification
NCEA Level 3 or Bursary or Scholarship
14 or more credits at any level
NCEA Level 1 or School Certificate
Overseas qualification, including
International Baccalaureate and Cambridge
International Exams (please specify)
CEA Level 2 or New Zealand Sixth
N
Form Certificate (one or more subjects)
Not known
University Entrance
Other (please specify)
(one or more subjects)
PREVIOUS EDUCATION
Please attach either your NZQA record of learning, your original academic transcript or a certified copy of either
document. Unitec reserves the right to contact any institution holding relevant academic records to confirm
information supplied.
Enter your National Student Number (NSN Number) here (if known).
SECONDARY SCHOOL /HIGH SCHOOL
The Ministry of Education requires this data to be collected before your application can be processed.
Write ‘overseas’ if applicable.
Secondary school/high school attended
When was your last year at secondary school/high school? (e.g. 2010)
If you are still at school, what subjects are you studying and at what level?
Subjects
Level
If you have no qualifications, please tick here
✔
TERTIARY STUDIES
TERTIARY STUDY AND/OR PROFESSIONAL QUALIFICATIONS
Please provide details of all previous and current tertiary study.
Qualification
Institution
Start date End date
Completed
In progress
Completed
In progress
Completed
In progress
Completed
In progress
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 4.
Unitec Application/Enrolment Form
SUPPORT
The Ministry of Education requires this data to be collected. The information you supply is confidential and will not
affect your application. Extra support may be available for students with certified medical conditions, disabilities/
impairments or learning difficulties. In order to be considered for this support, students must provide the information
below. Please note, an offer of place on a programme made prior to an assessment for your declared disability does
not mean that support is available. We are unable to guarantee any support without an assessment. If you have any
queries please contact the Disability Liaison Centre at disabilitysupport@unitec.ac.nz
Do you live with the effects of an injury, long-term illness or disability, or do you identify as being Deaf?
Yes
✔ No
Please specify the type of your injury, illness or impairment
Blind Deaf
Hearing
Head injury Physical Mobility Specific learning Speech
Medical
Vision Mental health
Temporary impairment
Other, please specify
Would you like to be contacted by the Disability Liaison Centre to be considered for support?
Yes
✔ No
Do you need a NZ Sign Language Interpreter or notetaker for classes or exams?
Yes
✔ No
In the event of an emergency, would you need help to evacuate the building?
Yes
✔ No
CAREER BACKGROUND SUMMARY
We invite applicants to tell us about any work experience relevant to their field of study. Please provide details of
your work experience in the section below or submit a CV with your application.
Have you attached your CV or other supporting documentation?
✔ Yes
No
Employer
Position
Start/end dates
Summary
What activities are you involved in (school, community, cultural, etc) that will support this application?
(You may continue on a separate page if you wish, writing your full name on any additional paper used.)
Why have you chosen this programme/s? Please indicate what type of employment interests you after graduating.
(You may continue on a separate page if you wish, writing your full name on any additional paper used.)
The language of instruction at Unitec is English.
If English is not your first language and you have an IELTS or TOEFL score (dated 2 years or less), please include a
certified copy of your original IELTS/TOEFL results. (Please note, you may be required to produce your original result notice.)
IELTS/TOEFL score
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 5.
Unitec Application/Enrolment Form
Please state other languages known and indicate your level of ability.
Native/fluent
Able to translate
Conversational
Native/fluent
Able to translate
Conversational
Native/fluent
Able to translate
Conversational
FEE PAYMENT
Confirmation of enrolment – will be provided in the form of an invoice.
Fee payments – are due seven days prior to the course start date. Access to Unitec services is dependent on your
fees being paid.
Unitec fees – include Tuition fee, Student Services fee, and GST. Depending on the programme taken, other approved
fees may be charged including Unit Standard fees, Examination fees, Audition fees, Course Material costs etc.
Student Loan – if paying by Student Loan, please telephone StudyLink for advice prior to the start of your
programme on 0800 88 99 00 or visit www.studylink.govt.nz
Indicate how you will pay your fees.
Cheque
Credit card
Student Loan
Other Please specify
IRD NUMBER
Providing your IRD number is voluntary and is used for a Student Loan interest write-off. For more information on interest-free student
loans, visit www.ird.govt.nz/studentloans.
PAYMENT OF FEES, WITHDRAWAL, REFUND AND CANCELLATION POLICY
Fees must be paid seven days prior to the course start date (this being the due date shown on the tax invoice/
statement) or a loan application must be in progress.
The current Unitec Admissions, Enrolments and Fees policy relating to fee refunds for New Zealand citizens and
permanent residents is listed below. This policy may be amended from time to time with the latest version available
on the Unitec website www.policies.unitec.ac.nz.
Refund Policy for New Zealand Citizens and Permanent Residents
» If a domestic student applies in writing to withdraw before the official class start date of the class a full 100% refund of fees paid
shall be given with the exception of any non-refundable deposit.
» If a student submits an application to withdraw from a course of 12 weeks or longer (or a course normally taught for 12 weeks or longer
that is being offered in condensed form in the summer school) on or before the 10% date of the course*, the student is entitled to a
refund of 90% of the fees paid and no record of the student’s enrolment will be entered onto the student’s academic record.
» If a student has paid a holding deposit and subsequently withdraws, the full deposit shall be retained or 10% of the total fee,
whichever is the greater. If the student who has withdrawn has not paid any fees, the normal 10% retained amount is to be
pursued through the debt collection process. Amounts under $100 remain a charge on the student’s account, and will be pursued
through the debt collection agency at the discretion of the Finance Committee. No further enrolments will be possible until this
balance has been paid.
» If a student withdraws in writing from a course/programme of 12 weeks or longer (or a course normally taught for 12 weeks or
longer that is being offered in condensed summer school form) after the 10% date but before the submission or sitting of the final
summative assessment, no refund is given, except in exceptional circumstances. Exceptional circumstances refunds require the
Application for Exceptional Refund of Fees Form to be lodged with Student Central (Te Pae Kōrero) within 30 days of the last day
of attendance or prior to the last day of the course whichever date is earlier, and require the approval of the Executive Dean of the
Faculty or their representative. In such cases a refund of fees may be given to a maximum of 30% of the fees paid.
» A student may change from one course/class to another course/class within the same semester and a direct transfer of fee will
take place in the student management system if the student applies to do so prior to the 10% date of the class in which the
student is enrolled. In the case of a change to a course/class with a higher fee then the student must pay the difference. If the
change is to a course/class of a lower fee then the difference shall be refunded.
» All domestic students with credit balances in their account shall be reviewed on a six monthly basis. Faculties will be contacted to
verify the credit and monies refunded appropriately.
» The Executive Dean of the Faculty (or person approved by him/her) is authorised within the limits of their financial delegated
authority to approve refunds for domestic students on a compassionate basis in exceptional circumstances (such as serious
illness, etc.) The amount of the refund will be at the discretion of the Executive Dean of the Faculty, or the person approved above
by him/her.
* Means the date which is 10% of the way through the course duration as defined by the number of days from the official class start
date to the class end date. The 10% date is defined as being 20% of the way through the first semester component of the double
semester course.
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 6.
Unitec Application/Enrolment Form
PERSONAL INFORMATION – PRIVACY ACT 1993
Unitec collects and holds personal information about students to comply with various statutes, including
the Education Act, the Public Finance Act and the Inland Revenue Act and to enable Unitec to make decisions
in relation to your tertiary study at Unitec and to provide you with information relevant to your study,
participation in the Unitec community and regarding services and facilities available to you. We may use
the personal information provided by you on this form to send you information about Unitec courses and
programmes that may be of interest to you. If you do not provide all or any part of the information requested on
this form, or if any information provided by you is not true and correct, then Unitec may refuse to process your
application or may terminate your enrolment.
Personal information collected on this form and other documents submitted to support this application may
be disclosed to academic and administration staff where relevant to their duties, and also where relevant to
other agencies such as the Ministry of Education, Tertiary Education Commission, New Zealand Qualifications
Authority, Inland Revenue Department, Ministry of Social Development, StudyLink, Ministry of Foreign Affairs
and Trade, Career Services, tribal trusts and scholarship providers, Immigration New Zealand, Industry Training
Organisations, Industry Licensing and Registration bodies, Ed. Collective, other tertiary institutions, previous
secondary schools and providers of work experience for students in courses with a practical component.
Please note that your name, date of birth and residency as entered on this enrolment form 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 https://nsi.education.govt.nz/home.aspx.
In addition, when required by law, Unitec will release information to government agencies such as the New
Zealand Police, Department of Justice, Inland Revenue, Ministry of Social Development and the Accident
Compensation Corporation.
You have the right to access and correct personal information about you which has been collected by Unitec, in
accordance with Unitec’s Privacy of Information Policy and Procedures, available at www.policies.unitec.ac.nz.
PLEASE NOTE THAT YOUR APPLICATION IS NOT COMPLETE UNTIL YOU HAVE SIGNED THE DECLARATION
ON THE NEXT PAGE.
COURSE ENROLMENT
Please complete this section ONLY if you know which courses you intend to take for the programme/s you are
applying for. (If you have been forwarded a selection sheet please complete and attach it here.)
Unitec Student ID Number
OFFICE USE
COURSE APPROVAL
Each course must be approved by the department teaching the course with the appropriate authorised signature.
Funding Source Initials Course no.
e.g. MATH 4001
Class no.
Course name
1010
Introduction to Statistics
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
Page 7.
Unitec Application/Enrolment Form
DECLARATION
» I declare that the information provided by me on this form is complete and correct. I also undertake that any further information I provide
to Unitec (whether for a change to my enrolment or applying for a new programme or otherwise) will also be complete and accurate.
» I understand that failure to disclose required information or the supply of incorrect information may result in my enrolment not being
processed, or in my enrolment being cancelled.
» I agree to abide by all Unitec statutes, regulations and policies as may be amended from time to time.
» I have read and accept the privacy and policy statements printed on page 7 of this form. I understand that I can access Unitec’s Privacy of
Information Policy on the Unitec website www.policies.unitec.ac.nz.
» I undertake to make prompt payment of fees as notified on the invoice confirming my enrolment.
» I understand that payment must be received within the due time and that, failing this, formal recovery action may be taken to recover
unpaid fees. Furthermore, I understand that I will be liable for all costs relating to such recovery.
» I agree that before I use the Internet at Unitec, I will familiarise myself with the Unitec’s Electronic Devices and Systems Policy and I will
abide by them. I accept that failure on my part to abide by this policy may lead to the termination of my access to the Internet via Unitec and
that I may be required to pay any internet-related costs incurred by my actions that do not accord with the policy and guidelines (as well as
reasonable costs of recovering those costs).
» I authorise the use of my computer login code for admission and enrolment purposes, I accept responsibility for all uses of my individual
computer login code and I agree not to give my computer login code or password to other users.
» I understand that Unitec may need to validate the information provided on this form and attachments. I authorise Unitec to collect
information for this purpose from any agency holding the source of this information.
» I consent to receiving electronic messages from Unitec in relation to goods, services and facilities that are available to me as a Unitec
applicant or student.
Signature Date
Day/Month/Year
CHECKLIST
Make sure your application can be processed.
Please note that all copies of your documentation must be certified by a Justice of the Peace (JP), Kaumatua or Solicitor or any
other authorised person as listed on page 2. You may also bring your original documents to Student Central (Te Pae Kōrero) for
staff to sight and verify.
Completed
all relevant sections on this form? (Note: Question 37 is optional and should only be completed if
courses have been selected.)
Attached certified proof of citizenship? (Question 14) i.e. at least one of the following:
1. New Zealand Birth Certificate
2. Certificate of New Zealand Citizenship
3. New Zealand Passport
4. Whakapapa
5. Cook Islands, Niue or Tokelau birth certificate
6. Immigration New Zealand document
Attached certified proof of New Zealand residency? i.e. passport with a current residency permit
Attached certified proof of academic qualifications? (Question 27)
1. IELTS/TOEFL score
2. NCEA or other secondary school results
3. Bursary results
4. Academic transcript
Completed an online Student Loan Application (if necessary)?
Read and signed the Declaration?
PLEASE RETURN THIS FORM TO:
Student Central
Unitec Institute of Technology
Private Bag 92025
Victoria St West
Auckland 1142, New Zealand
PLEASE DO NOT FAX OR EMAIL THIS FORM. FAXED OR EMAILED COPIES WILL NOT BE ACCEPTED.
U008773/0914/300
Page 8.
Unitec Application/Enrolment Form