The Design School. Level 3 & 4 Bridging Course Enrolment Form 2015

Transcription

1 The Design Schl Level 3 & 4 Bridging Curse Enrlment Frm 2015 P O Bx 642 Palmerstn rth Phne: Fax: enrl@designschl.ac.nz Web: Welcme t The Design Schl. Please read the instructins belw carefully befre yu cmplete this enrlment frm. Applicatin fr : Palmerstn rth Gisbrne Whangarei INSTRUCTIONS The purpse f this enrlment frm is t get frm yu the infrmatin we need t enrl yu int a qualificatin at The Design Schl. We als need t cllect infrmatin frm yu which is required by the Ministry f Educatin, Tertiary Educatin Cmmissin and ther Gvernment agencies fr statistical, registratin and mnitring reasns. Please fill in the frm prperly by: Cmpleting all sectins f the frm. Printing yur answers clearly in pen, r ticking the bx that applies fr multi-chice questins. Signing the frm. Attaching t the frm additinal dcumentatin that is required fr Ministry f Educatin and Tertiary Educatin Cmmissin funding purpses. A descriptin f the required dcumentatin is prvided n page 4 f the frm. A QUALIFICATION 1 Please write the name f the qualificatin in which yu wish t enrl in 2015: Start Date fr this perid f enrlment: Planned Finish Date fr this perid f enrlment: Drawing and Design: An Intrductin t Tday s Technlgy 2 nd February 2015 r 30 th Octber 2015 r Office Use: Student ID D yu intend t study: Part time Full time 2 Have yu studied at The Design Schl befre? If yu answered yes, what was yur ID number? 3 Please enter the name(s) f the curses int which yu wish t enrl in 2015: Year One Cmpulsry curses (Tick curses) Year Tw Cmpulsry curses (Tick curses) Generic cmputing 1 Generic cmputing 2 Cmputer aided design 1 Cmputer aided design 2 Design - cmputer graphics 1 Generic design 2 Generic design 1 Design - graphic cmmunicatin 2 Design - graphic design 1 Applied art 2 Design - graphic cmmunicatin 1 Wrk and study skills 2 Applied art 1 Self management 2 Architectural drawing 1 Cultural identity 2 Fashin Design Optinal Mdule Fashin Design Optinal Mdule B PERSONAL DETAILS 4 Print yur full legal name: Family Name Given Name(s) 5 Preferred first name: 6 If yu have previusly enrlled at this r any ther tertiary institutin under anther name, what was that name? 7 Preferred title: Ms Miss Mrs Mr Other (Specify): 8 Date f birth: 9 Gender: Male Female day mnth year

2 10 If yu have an a Natinal Student Index number (als knwn as the NSN r NZQA Recrd f Learning number), please write it here: Citizenship and Residency: Please fllw the flw chart belw and tick the apprpriate bx(es). If yu are nt a New Zealand r Australian citizen yu will have t specify yur citizenship in the shaded bx. Are yu a New Zealand r Australian citizen? Tick ne bx: New Zealand Australian Specify yur cuntry f citizenship (fr students with dual citizenship specify the cuntry f citizenship used t enter New Zealand). Cuntry f Citizenship: Are yu a New Zealand r Australian Permanent Resident? New Zealand Citizen Australian Citizen Tick ne bx: New Zealand Permanent Resident Australian Permanent Resident During yur time studying this qualificatin will yu be living in New Zealand r verseas? Tick ne bx: New Zealand Overseas Tick Dmestic Student in the list belw. In New Zealand Overseas Dn t tick Dmestic Student in the list belw. Tick anther bx. Meta Office 2014 Yu may/will need t supply evidence f residency status r citizenship w using the flw chart tick ne f the bxes belw: Dmestic Student 00 NZAID student 01 Internatinal Fee-Paying Student (including peple 03 n current wrk visa) Student n a recgnised exchange scheme 04 Freign research based pst-graduate 06 Visiting military persnnel, diplmatic staff r family, r 08 persns assciated with Antarctic prgramme Internatinal n-shre PhD student 09 Internatinal student wh is ITO ff-jb trainee 12 Refugee r prtected persn whse applicatin fr residence 13 is being prcessed r a persn wh has made a claim t be recgnised as a refugee r prtected persn and hlds a valid temprary visa. If yu are a New Zealand r Australian permanent resident, r an Australian Citizen, please specify in years and mnths hw lng yu have resided in New Zealand with a residence class visa, r with Australian citizenship: Years: Mnths:

3 12 Ethnicity: What ethnic grup(s) d yu belng t? Yu may tick up t three bxes which apply t yu. NZ Eurpean/Pakeha 111 New Zealand Māri 211 Saman 311 Ck Island Māri 321 Tngan 331 Niue 341 Tkelauen 351 Fijian 361 Other Pacific Peples * 371 British/Irish 121 Dutch 122 Greek 123 Plish 124 Suth Slav 125 Italian 126 German 127 Other Eurpean * 129 Australian 128 Filipin 411 Cambdian 412 Vietnamese 413 Other Sutheast Asian * 414 Chinese 421 Indian 431 Sri Lankan 441 Japanese 442 Krean 443 Other Asian * 444 Middle Eastern 511 Latin American 521 African 531 Other * 611 t Stated Iwi: If yu identified as New Zealand Māri in questin 12, what is the name f yur iwi (tribe r tribes) and rhe? Yu may enter mre than ne iwi. If yu d nt knw yur iwi, please enter Dn't Knw. A list f rhe and iwi can be fund at Te Puni Kõkiri * Please specify if Other Pacific Peples, Other Eurpean, Other Sutheast Asian, "Other Asian" r "Other. Iwi: Rhe (iwi hme area): Iwi: Rhe (iwi hme area): Iwi: Rhe (iwi hme area): Office Use 14 Prir activity: What was yur MAIN activity r ccupatin in New Zealand at 1 Octber 2014? Yu may tick nly ne bx. Secndary schl student 01 n-emplyed r beneficiary (excluding retired) 02 Wage r salary wrker 03 Self-emplyed 04 University student 05 Plytechnic r Institute f Tech. student 06 Huse-persn r retired 08 Overseas (irrespective f ccupatin) 09 Private training establishment student 11 Wānanga student Disability (the cmpletin f this sectin is nt cmpulsry): D yu live with the effects f significant injury, lng term illness, r disability? The infrmatin yu supply is cnfidential. If, hw wuld yu describe yur impairment, disability, r lng term medical cnditin:

4 C ACADEMIC INFORMATION 16 Secndary Schl: What was the name f the last secndary schl yu attended? State verseas, if applicable. Office Use What was yur last year at secndary schl? What is the highest level f achievement yu hld frm a secndary schl? Yur highest achievement may be a traditinal award such as Schl Certificate, r yu may have achieved a number f credits r a Natinal Certificate at a certain level n the Natinal Qualificatins Framewrk. Yur NZQA Recrd f Learning shws yu hw many credits yu have. Tick nly ne bx. frmal secndary qualificatins r mre credits at any level 11 NCEA Level 1 r Schl Certificate 12 NCEA Level 2 r 6th Frm Certificate 13 University Entrance 14 NCEA Level 3 r Bursary r Schlarship 15 Overseas qualificatin (includes Internatinal Baccalaureate & Cambridge Exams) * 09 Other * 98 t knwn 99 * Please specify if Overseas qualificatin r Other. 17 Tertiary Study: Will this be the first year yu have ever enrlled in a University, Plytechnic, Institute f Technlgy, Cllege f Educatin, Private Training Establishment, r Wānanga either in New Zealand r verseas since leaving schl? D nt include enrlments in STAR, cmmunity r hbby classes. If yu answered, please enter the name f the institutin yu studied at and year f yur first enrlment. Name Year If yu have cmpleted ne r mre tertiary qualificatins enter the name f the highest level qualificatin. Name Level (if knwn) What year d yu expect t cmplete the academic requirements necessary t graduate frm yur qualificatin? Year 18 English Language: Is English yur first language? 19 Literacy & Numeracy fr Adults Have yu used the Literacy & Numeracy fr Adults assessment tl? What type f assessment(s) did yu d? Reading Writing Vcabulary Numeracy

5 D IRD NUMBER COLLECTION FOR STUDENT LOAN INTEREST WRITE-OFF 20 D yu currently have r will yu have a Student Lan this year? Please g t the next sectin Please enter yur IRD number here (see belw fr mre infrmatin n interest write-ff) IRD number: - - Interest Free Student Lans and ther Interest Write-ffs On 1 April 2006, legislatin was intrduced t make student lans interest free fr brrwers living in New Zealand. Cmpleting yur IRD number is vluntary. This is requested s the Ministry f Educatin can share infrmatin with IRD regarding Student enrlments. If yu chse t prvide yur IRD number n the enrlment frm this will be included with yur enrlment details and will be reprted t the Ministry f Educatin. Fr mre infrmatin n interest free student lans, visit E DOCUMENTATION 21 T qualify as a dmestic student, and s be entitled t the Gvernment tuitin subsidy, yu must be a citizen f New Zealand (including students frm the Ck Islands, Tkelau, r Niue wh have New Zealand citizenship) r a permanent resident f New Zealand r a citizen r permanent resident f Australia residing in New Zealand. Yu must prvide evidence f citizenship r permanent residency and t d s yu must prduce ne f the fllwing: Birth certificate with place f birth stated as New Zealand, Ck Islands, Tkelau, r Niue. An assertin thrugh RealMe that yu were brn in New Zealand (prir t 2005). New Zealand passprt. A statement f Whakapapa, including date f birth, cuntersigned by a kaumatua. Certificate f citizenship r letter f cnfirmatin. Overseas passprt with residency stamp. Australian learners wh are living in New Zealand must supply ne f the fllwing dcuments: birth certificate, Australian passprt, current Returning Resident's Visa if yu are an Australian permanent resident. Yu can bring the riginal dcumentatin t The Design Schl, alternatively please prvide a certified cpy. This means a phtcpy f yur riginal dcument, signed as being a true and accurate cpy by a Justice f the Peace (JP), Barrister r Slicitr, tary Public, Curt Register r Deputy Registrar, Member f Parliament, Land Transprt New Zealand, Public trust, r lcal authrity emplyee designated fr this purpse. When a learner is in a remte cmmunity and unable t access a persn listed in the Oaths and Declaratins Act, a member f the New Zealand Plice, schl principal, minister f religin, r general practitiner is acceptable. Internatinal students must bring their passprt with them when they enrl. Please nte that yur name, date f birth and residency as entered n this enrlment will be included in the Natinal Student Index, and will be used in an Authrised Infrmatin Matching prgramme with the New Zealand Birth Register. Fr further infrmatin please see the Natinal Student Index web site 22 Please list here all dcuments that yu have attached t this enrlment frm. Dcuments shuld be securely stapled t the back f the frm. F BANK ACCOUNT 23 Please prvide details f yur bank accunt fr the depsit f items such as Travel Allwances (If eligible). - Bank Branch Accunt Number Suffix Name f Bank: Name f Branch: Twn/City:

6 G CONTACT DETAILS 24 Address and cntact details: Permanent Address: Term Time Address: (if different frm permanent address) Pst Cde: Pst Cde: Phne: Alternative ( Phne: ) Mbile: ( ) Fax: What is yur pstal address? Permanent Address Term Time Address Other If yu ticked Other please write yur pstal address belw. Pst Cde: Next f Kin: Name and address: Phne: Relatinship t Yu: DECLARATION Privacy The Design Schl cllects and stres infrmatin frm this frm t: Manage the business f The Design Schl (including internal reprting, administrative prcesses and selectin f schlarship and prize winners if any). Cmply with the requirements f the Educatin Act 1989 and ther legislatin relating t maintenance f recrds and accuntability fr public funding. Supply infrmatin t gvernment agencies and ther rganisatins as set ut belw. In signing this enrlment frm yu authrise such disclsure n the understanding that The Design Schl will bserve the cnditins gverning the release f infrmatin, as set ut in the Privacy Act 1993, the Educatin Act 1989 and ther relevant legislatin. Yu may see any infrmatin held abut yu and amend any errrs in that infrmatin. T d s, cntact the Head f Schl. NB: The Privacy Act came int frce n 1 July 1993 with the stated aim f prtecting the privacy f natural persns. It requires The Design Schl t cllect, hld, handle, use and disclse persnal infrmatin in accrdance with the twelve infrmatin privacy principles in the Act which can be viewed n the Privacy Cmmissiner s web site: Supply f Infrmatin t Gvernment Agencies and Other Organisatins The Design Schl supplies data cllected n this frm t gvernment agencies, including: The Ministry f Educatin. The New Zealand Qualificatins Authrity. The Tertiary Educatin Cmmissin. The Ministry f Scial Develpment (in relatin t student lans and allwances) and Inland Revenue (student lans). Immigratin New Zealand and the Ministry f Business, Innvatin and Emplyment (fr thse wh are nt New Zealand citizens r permanent residents). Agencies wh supprt particular students thrugh schlarships, payment f fees r ther awards (if yu are a recipient f ne f these awards). Thse agencies use the data cllected frm tertiary educatin rganisatins t: Administer the tertiary educatin system, including allcating funding. Develp plicy advice fr gvernment. Cnduct statistical analysis and research. Yur persnal details (name, date f birth and residency) as entered n this frm will be included in the Natinal Student Index, if nt already registered, and may be used in an authrised infrmatin matching prgramme with the New Zealand Birth Register. The gvernment agencies abve may supply data cllected n this frm t Statistics New Zealand fr the purpses f integrating data with data cllected by ther gvernment agencies, subject t the prvisins f the Statistics Act Integrated data is used fr the prductin f fficial statistics, t infrm plicy advice t gvernment and fr research purpses. In handling data supplied by yu n this frm, the gvernment agencies are required t cmply with the prvisins f the Privacy Act When required by law, The Design Schl releases infrmatin t gvernment agencies such as the New Zealand Plice, Department f Justice, Ministry f Scial Develpment, and the Accident Cmpensatin Crpratin (ACC). Infrmatin cllected n this frm may be supplied t ther educatinal rganisatins fr the purpse f verifying academic recrds. Fees In signing this enrlment frm yu undertake t pay all fees as they becme due, and t meet any late fees and cllectin charges assciated with debt recvery. The Design Schl s plicy n withdrawal and refund f fees may be btained frm the Head f Schl. Rules In signing this enrlment frm yu undertake t cmply with the published rules and plicies f The Design Schl with regard t attendance, academic integrity and prgress, cnduct and use f infrmatin systems. Identity - If yu have supplied a Natinal Student number n this enrlment frm, and yur Natinal Student Index status is verified, yu are deemed t have declared that yu are the legitimate wner f the claimed identity. Declaratin I declare that t the best f my knwledge all the infrmatin supplied n, and with, this enrlment frm is true and cmplete, I agree t abide by the cnditins described abve, and I cnsent t the disclsure f persnal infrmatin as described abve. / / Signature Date Please make sure that yu sign yur enrlment frm abve

7 H ENTRY PROFILE The Design Schl wishes t prvide relevant and effective training. We cllect infrmatin frm students t help us d this. At the time f enrlment we cllect infrmatin abut what yu were ding prir t enrlment. This is yur entry prfile. Later we will cllect feedback frm yu n what yu think f ur rganisatin and yur experience f studying with us and, after yu have finished yur studies, we will cllect infrmatin n yur emplyment and further training. It wuld be appreciated if yu culd cmplete the questins belw t prvide us with entry prfile data. The data is treated cnfidentially and we d nt cntact any rganisatins named by yu. 24 Educatin and Training What is the mst recent study yu have dne since leaving schl? Name f Qualificatin: Where did yu study the qualificatin: Did yu cmplete this qualificatin: Did yu study part time r full time: Part time Full time 25 Emplyment What is the mst recent emplyment? Psitin: Emplyer: Did yu wrk part time r full time: Part time Full time 26 Marketing Hw did yu learn abut the curses at The Design Schl? CHECKLIST: ITEMS TO BE PROVIDED WITH APPLICATION Curse Pre-entry requirements als required and 300 wrd essay Why yu wuld benefit frm this curse including a brief utline f yur career plan Verified phtcpies f dcuments prving student eligibility (Sectin E) Academic recrds (D nt send riginals) One reference Prepare a prtfli f wrk t be presented at interview r cmplete a design prject supplied by The Design Schl THE APPLICATION PROCESS Cmplete applicatin frm and send it t The Design Schl Yu will receive acknwledgment by letter. We will advise yu if yu need t supply further infrmatin. Selected students will be invited fr interview Successful applicants will be infrmed and infrmatin will be sent by the Schl regarding enrlment and fees If applicatin is unsuccessful yu will be infrmed as sn as pssible Office Use Only Dcumentatin / / Apprved / / Entered / /