Application to Graduate
This form must be returned to the cashier at the Porirua campus no later than 30 November 2010.
Graduand Details
First Name____________________________________Last Name____________________________
Address___________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Student ID___________________________________________
Faculty_____________________________________________
Programme__________________________________________
Yes, I will be attending Graduation on Friday, 17 December 2010
Continue completing this form
No, I am unable to attend Graduation. Please post my award to the above address.
Sign below and return to Whitireia Community Polytechnic, Private Bag 50910 Porirua.
_________________________________________________________(signature)
Graduate names will be listed in the Dominion Post and in the Graduate Handbook. Please tick here if
you DO NOT wish your name to be included in these lists.
Email address
Phone number
Mobile number
Phonetic spelling (if your name is difficult to pronounce)
Seating Requirements
Graduand Seating
Graduands attending the ceremony will be allocated a seat alphabetically by programme. Please advise if you
have any special seating requirements:
Guest Seating
Please indicate below how many seats you would like. You will be contacted the week before the ceremony if
the number is not possible. Please complete the following, even if you do not require any guest seats.
I would like to request
adult and
child seats to the ceremony at 11am / 4pm (circle)
Please advise if any of your guests have any special seating requirements:
Regalia
All graduands are required to wear academic dress. We require your height to order you the correct gown size. A
height chart will be available by the cashier in the Information & Enrolment Centre.
Height in centimetres:
Payment Details (for Regalia)
Certificate graduands pay $25 for gown hire. Diploma graduands pay $32.50 for gown and stole hire.
Please complete and return to the cashier at the Whitireia Polytechnic Porirua campus or send in self addressed
envelope enclosed.
Amount Due: ____________
Please indicate payment method:
Online Banking
Please make payment to the following account and return forms as above:
Account Name:
Account Number:
Particulars:
Code:
Reference:
Whitireia Community Polytechnic
12-3244-0004001-000
Graduation 2010
[STUDENT_ID]
21-307-1500
Cheque
Please make cheque payable to Whitireia Community Polytechnic.
Credit Card
Visa
Card Number:
MasterCard
-
-
-
Expiry:
/
Cardholder’s
Name:
Cardholder’s
Signature:
Declaration
I have read, accept and agree to abide by the Conditions of Hire as stated below.
Signed
Date
Conditions of Hire
 You are required to return regalia in good condition upstairs at Te Rauparaha Arena immediately
following the ceremony.
 You will be charged for the value of any non returned or damaged regalia, and will also be liable for
debt collection costs.