APPLICATION TO GRADUATE 2015 (FOR 2014 ACADEMIC YEAR)
Please complete this form and return to:
Graduation Committee, PO BOX 12 747, Penrose, Auckland 1642, OR Fax 09-579 5150
OR Email ruth.martin@acnz.ac.nz
Deadline for submission- Application forms for students wishing to graduate at the following ceremony
MUST be lodged with the Graduation Committee no later than 27th March.
Late applications will be considered but not guaranteed.
Graduation Ceremony details:
When: April 11, 2015 @ 2pm (Graduating students must arrive by 12.45pm).
The ceremony will be followed by afternoon tea.
Where: Alphacrucis College Campus, 60 Rockfield Rd, Penrose, Auckland
SECTION A – STUDENT DETAILS (please fill out and print clearly)
Student ID Number:
____________________________________________________
Family name:
____________________________________________________
Given name:
____________________________________________________
Formal name*:
____________________________________________________
Your formal name is the name that will appear on your award and must be your legal name as per your
Birth Certificate, Marriage Certificate or Passport.
Qualification:
Current email:
_________________
Current address:
_______________________________________
_______________________________________ Tel / Mobile:
__________________________________________________________________
To the best of my knowledge I have completed (or expect to complete with my current enrolment) the
course specified above by achieving passing grades or having gained exemptions from units required for
this course. I understand that if I have outstanding fees, fines or library books I will not be eligible to
graduate at the current graduation ceremony.
Signature of applicant: ____________________________________
Date: ___________________
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SECTION B - COSTS FOR GRADUATION 2014
All students graduating at Diploma and Degree Level are required to have complete graduation regalia.
Photo CD: $15 
Level 4: $30 
Level 5: $50 
BCMIN: $70 
Please note Alphacrucis College will arrange the provision of graduation gowns, hoods, sashes and
trenchers. The photo CD will include all the graduation photos.
Payment Method:
Cheque (Please make this to Alphacrucis Ltd)
Cash
EFTPOS
Online Banking (Westpac, Alphacrucis Ltd, 03-1500-0027941-03, Reference: Student Name Grad Fees)
SECTION C – GRADUATE INFORMATION SURVEY
Please tick the appropriate boxes:
 I am currently employed in a position relating to my study  part time  full time
 I am seeking employment  I am engaged in volunteer work
For more information or any queries, please contact Ruth Martin at 09-580 1500 or email
info@acnz.ac.nz
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