INR

WELCOME TO MANUKAU INSTITUTE OF TECHNOLOGY YOU MUST SIGN THE

STUDENT DECLARATION

New International Student ON PAGE 3 OF THIS FORM.

Registration Form
Please complete all sections of this form. Please print clearly in pen using BLOCK LETTERS.
This form is to be For multi-choice boxes, tick the box that applies.
completed only
by applicants who 1 STUDENT DETAILS
are International
Students. Returning MIT Student ID Number (if known): If you are new at MIT we will
International (8 or 9 numbers) create an ID number for you.
Students, please Please PRINT your legal name in full (as on your passport).
complete an
Legal family name
International Student
Re-enrolment Legal first given name
form which is
available from Legal second given name
MIT International.
Manukau Institute If you are not commonly called by your legal name(s), what do you prefer to be called?
of Technology is a Preferred family name
state-funded tertiary
provider, and as such Preferred first name
we are required to
provide statistical Preferred Title
information to the Miss Mrs Ms Mr Dr Other (please state)
Ministry of Education.
All sections of Gender
this form must be Female Male DATE OF BIRTH / /
completed and DAY MONTH YEAR
all the necessary
documentation Do you have medical and travel insurance? Please provide a copy of the Insurance Policy.
provided, to enable
Yes No Insurance Company name
your enrolment to be
fully processed.
NATIONAL STUDENT INDEX NUMBER (NSN) / NZQA NUMBER
If you know your National Student Index
NSN / NZQA Number
Number or NZQA number, please write it here.
This system, introduced by the Government, allocates every New Zealand tertiary student and NCEA candidate a
unique number - NSN. To check information about your NSN, go online at: www.minedu.govt.nz/goto/nsi

CITIZENSHIP
To register and enrol, International students must provide their overseas passport with a current visa
(student/visitors/work). Bring your passport when you come to register and enrol.

Country of citizenship

ETHNIC ORIGIN - TICK ONE BOX ONLY (I.E. THE ETHNIC GROUP YOU MOST IDENTIFY WITH)

111 New Zealand 122 Dutch 414 Other Southeast Asian

European/Pakeha
123 Greek 421 Chinese
211 New Zealand Ma- ori
124 Polish 431 Indian
311 Samoan
125 South Slav 441 Sri Lankan
321 Cook Island Ma- ori
126 Italian 442 Japanese
331 Tongan
127 German 443 Korean
341 Niue
128 Australian 444 Other Asian
351 Tokelauen
129 Other European 511 Middle Eastern
361 Fijian
411 Filipino 521 Latin American
371 Other Pacific Peoples
412 Cambodian 531 African
121 British/Irish
413 Vietnamese 611 Other

Please specify if “Other Pacific Peoples”, “Other European”,

“Other Southeast Asian”, “Other Asian” or “Other”.

Optional: If you identify yourself with additional ethnic groups you may enter two other numbers.

1. 2.

MANUKAU INSTITUTE OF TECHNOLOGY | NEW INTERNATIONAL STUDENT REGISTRATION FORM PAGE 1

INR 2016
 2 CONTACT DETAILS

Permanent/home country address

Town/city Country

Phone ( ) Cellphone

Email address

Work/business/postal address
Company name (if relevant)

Postal address

Town/city Country

Phone ( ) extn Cellphone

Email address

Address while studying in New Zealand

Unit/Flat/Apartment number

Street address - number and name

Suburb Town/city Postcode

Phone ( ) Cellphone

Email address

Emergency Contact (Next of kin)

Name

Phone Home ( ) Work ( ) Cellphone

Relationship (e.g. parents or next of kin)

3 OTHER DETAILS

ACADEMIC INFORMATION
What was the name of the last secondary school you attended? If study was overseas, write “overseas”.
When was your last year
at secondary school?

What is your highest school qualification? Tick ONE box only.

00 No formal secondary qualification 09 Overseas qualification (included international

Baccalaureate and Cambridge exams)
11 14 or more credits at any level Please specify

12 NCEA Level 1 or School Certificate

98 Other
13 NCEA Level 2 or 6th Form Certificate Please specify

14 University Entrance 99 Not Known

15 NCEA Level 3 or Bursary or Scholarship First year of tertiary education

Please note: If you have attended a tertiary institution since leaving school e.g. Polytechnic, University, College of
Education, Wananga or Private Training Establishment either in New Zealand or overseas, (not including STAR, community
or hobby classes), please write in the year you first enrolled. If this year is your first year please write 2015.

STATISTICAL INFORMATION
What was your prior activity or occupation as at 1 October last year? Tick ONE box only.

01 Secondary school student 04 Self-employed 08 Houseperson or retired

02 Unemployed or other 05 University student 09 Overseas (irrespective of occupation)

beneficiary (excluding retired)
06 Polytechnic student 11 Private Training Establishment student
e.g. DPB, sickness, ACC

03 Wage/salary worker 07 College of Education 12 Wananga student

student

PAGE 2 MANUKAU INSTITUTE OF TECHNOLOGY | NEW INTERNATIONAL STUDENT REGISTRATION FORM

 If you have attended a Private Training Establishment (PTE) write the name and the year of the last one you attended

PTE name Year

LANGUAGES
What is your first language?

English

Other. Please state your first language

PROGRAMME TO BE STUDIED
What programme are you applying for? e.g. (Degree/Diploma/Certificate/Certificate of Achievement or other).

Name of programme Start date

4 PRIVACY

Manukau Institute of Technology (“MIT”) observes the principles governing the release of personal information as set out in the Privacy Act 1993 (“the Act”).
‘Personal information’ is defined in the Act as “information about an identifiable individual”; it may include, but is not limited to, information such as
your name, age, postal and email address, telephone numbers, IRD, course of study, bank account and credit card details.
MIT’s primary purpose in the collection and storage of your personal information as a student is to provide you with the course of study for which
you are enrolled, and to comply with various legislative reporting requirements. MIT may also collect and use your personal information for other
purposes related to your course of study including corresponding with you for academic and administrative matters, publishing any award/s conferred
on you by MIT during graduation, and sending you information about MIT courses and programmes that may be of interest to you. MIT may also seek
personal information from other educational institutions and/or government agencies or other authorities for the purpose of verifying and maintaining
information relating to your academic records.
MIT contracts out certain aspects of MIT’s support services/IT administration to external contractors which may mean that MIT’s external contractors
may have access to your personal information e.g. MIT’s subsidiary that we use to manage and deliver certain courses and specific IT contractors that
MIT may use to maintain its IT systems. MIT’s contractors are required to sign confidentiality agreements and as such are only authorized to use or
access personal information in order to deliver the functions/services that MIT has requested.
Personal information collected on this form and at other times during and relating to your enrolment at MIT may be disclosed to MIT academic and
administrative staff where relevant to their duties, to other educational institutions for the purpose of verifying and maintaining academic records, and
to Government agencies or other authorities as permitted or required by law. If you are a recent school/ Private Training Establishment (PTE) leaver,
MIT may also advise your school/PTE when you first enrol (including details of what programme you have enrolled in) and when you complete an MIT
qualification. Please note that your name, date of birth and residency status 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 go online
at www.minedu.govt.nz/goto/nsi. You have the right to access and have corrected, personal information about you which has been collected by us.

5 DECLARATION
COMPULSORY
Please ensure you
read, sign and date
the declaration.
CHECKLIST
Student: Please ensure
you have completed or
supplied the following,
otherwise your enrolment
cannot be processed.
Completed all relevant
sections on this form?
 ttached verified
A • I authorise MIT to collect information for this purpose from any agency holding the source of this information.
photocopies of
passport and
current visa?
Completed medical
and travel insurance
requirements?
• I declare that the information provided by me on this form is true and correct.
• 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 MIT statutes, regulations and policies as may be amended from time to time. Copies are available on the MIT website
manukau.ac.nz. In particular, you should note the MIT Student Regulations, Computer User Regulations (IT Policy 1) and the regulations applying
to your programme of study.
• I have read and accept the Privacy and Policy statements printed on this form.
• I acknowledge that all MIT courses and programmes will proceed subject to enrolment numbers and MIT has the right to cancel or postpone an
offering of a course or programme prior to its commencement if there are insufficient enrolments.
• I undertake to pay all fees and charges relating to my enrolment and to meet all collection charges associated with debt recovery. Fees must be
paid in full, or a signed agreement made for their payment in instalments, by the start of the course. MIT may take such steps as necessary to
collect outstanding fees. Refunds and withdrawals will be processed in accordance with the MIT International Policy.
• I acknowledge that MIT may refuse to permit or may cancel my enrolment, on any of the grounds set out in the Student Regulations. This includes,
but is not limited to, where I am found not to be of good character (including, but not limited to: having a bad debt history; a criminal conviction;
or a history of breaching MIT regulations or policies); have been guilty of misconduct or a breach of discipline; am enrolled for full-time instruction
in another institution or secondary school; or have made insufficient progress in my studies. I further acknowledge that MIT may withdraw my
enrolment from a course where I have not attended in the first three weeks.
• I understand that is it my responsibility to ensure that my visa is current at all times and that MIT has the right to cancel my enrolment and retain
the tuition fee if my visa has expired while studying at MIT.
• I understand that MIT may need to validate the information provided on this form and attachments.
Applicant
Signature /
DAY /
MONTH YEAR
Note: If you are signing on behalf of the student, you must have the necessary authorisation through legal guardianship or power of attorney.
PLEASE DO NOT FAX THIS FORM. FAXED COPIES WILL NOT BE ACCEPTED.

Read and signed

6 PLEASE RETURN THIS FORM TO MIT INTERNATIONAL
the declaration?
Manukau Institute of Technology, Private Bag 94006, Manukau 2241, Auckland, New Zealand

OFFICE USE ONLY

Office Use Only

Documentation Entered
/ / / /

MANUKAU INSTITUTE OF TECHNOLOGY | NEW INTERNATIONAL STUDENT REGISTRATION FORM PAGE 3

 MANUKAU INSTITUTE OF TECHNOLOGY

MIT OTARA CAMPUS MAP

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FACULTY OF CONSUMER SERVICES FACULTY OF EDUCATION AND SOCIAL SCIENCES FACULTY OF ENGINEERING AND TRADES
School of Baking and Patisserie – JKL Block, K206 Employment Programmes – Q Block, Q101 School of Automotive and Vehicle Technology –
School of Culinary and Hospitality Studies – School of Education – ND Block, ND107 D Block, D101
NT Block, NT Reception School of English – JKL Block, J104 School of Building and Construction – NJ Block, NJ106
School of Hair and Beauty – JKL Block, K206 School of Foundation Studies – B Block, B101 School of Electrical Trades – P Block, P101
School of Horticulture, Landscaping, Floristry School of Secondary-Tertiary Studies – School of Engineering – P Block, P101
and Conservation – NH Block, NH101 NK Block, NK101 School of Mechanical Trades – D Block, D101,
School of Social Services – ND Block, ND107 School of Plumbing and Gas Fitting – NJ Block, NJ106
FACULTY OF CREATIVE ARTS School of Sport and Recreation – NL Block, NL101
School of Creative Writing – Z Block, Z139 STAR AND GATEWAY OFFICE
School of Performing Arts – Z Block, Z139 INTERNATIONAL CENTRE JKL Block, L118
School of Visual Arts – Z Block, Z139 G Block, G101

FACULTY OF NURSING AND HEALTH STUDIES

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NEW ZEALAND FLORISTRY MIT PUKEKOHE MIT MANGERE MIT KOLMAR

MARITIME SCHOOL
Floramax Flower Motorsport Centre Plumbing & Gasfitting, Sport & Recreation,
Level 3, Auction House, 159A & C Manukau Road, 9B Mahunga Drive, Sutton Crescent,
2 Commerce Street, 3 Monahan Road, Pukekohe Mangere Papatoetoe
Auckland CBD Mt Wellington

INR 2016
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