COURSE ENROLMENT FORM

If you have not studied with MIT before, we require a certified copy of your passport/birth certificate to show NZ
citizenship or Permanent Residency. Do not send original documents. MIT is not responsible for loss of or damage to
original documents.

SECTION 1: BASIC DETAILS

1 First Name(s):

2 Preferred First Name (if different to question 1):

3 Family Name:

4 Please let us know here if you have used any other name(s):

5 What is your preferred title?

 Miss  Ms  Mr  Mrs  Other - Please specify:

6 Gender  Male  Female

7 Date of Birth (DD/MM/YYYY) / /

8 National Student Number (NSN) – if known:

9 MIT Student ID – if applicable:

10 IRD Number – if known:

11 Tick the box which best describes your citizenship:

 New Zealand Citizen (skip question 12)  New Zealand Permanent Resident
 Citizen or Permanent Resident of Australia,  Other (International Student)
Cook Island, Niue or Tokelau

12 Country of Citizenship:

SECTION 2: STUDY DETAILS

Please enter the programme or course which you would like to enrol in

13 A Programme/course name:

B Programme/course code:

C Start date:

D Will you be studying full time or part time?  Full time  Part time  Unsure

E Do you expect to complete your qualification this year?  Yes  No

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Course_Enrolment_L2Validation_2018_v1
SECTION 3: CONTACT DETAILS

14 Email address:

15 Home phone number:

16 Mobile phone number:

17 Home Address:
Address

City
Country Post code

18 If you will be living at another address while studying, please let us know here:
Address

City

Country Post code

19 Please provide the contact details of an emergency contact:

Name:

Phone number:

Relationship to you:

SECTION 4: PERSONAL DETAILS

20 What ethnic group(s) do you belong to? You may tick up to two boxes.

 New Zealand Māori  New Zealand European/Pakeha  African

 Australian  British/Irish  Cambodian
 Chinese  Cook Island Māori  Dutch
 Fijian  Filipino  German
 Greek  Indian  Italian
 Japanese  Korean  Latin American
 Middle Eastern  Niuean  Other Asian
 Other European  Other Pacific Peoples  Other Southeast Asian
 Polish  Samoan  South Slav
 Sri Lankan  Tongan  Tokelauan
 Vietnamese  Not stated
 Other: Please specify:

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 21 If you have selected New Zealand Māori, please enter which Iwi you are from (enter up to three). If you
are unsure of your Iwi, please write ‘Unsure’.

22 Do you have a health issue or disability that might affect your ability to participate in the
programme/course you are applying for?

 Yes  No

SECTION 5: STATISTICAL INFORMATION

23 What was your MAIN activity or occupation in New Zealand at 1 October 2017? You may tick only one
box.

 Secondary school student  Wage/salary worker  University student

 House person or retired  Private Training Establishment  Unemployed or other
student beneficiary
 Self-employed
 Overseas (irrespective of  Wānanga student
 Polytechnic student occupation)
 Other
24 What was the name of the last secondary school you attended? If the last secondary school you studied
at was overseas, write “Overseas”.

25 What was your last year at secondary school? e.g. 2016

Please enter the last year you were at secondary school, even if you were not there for a full year.

26 First year of tertiary education. e.g. 2016

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 you have not had any
tertiary education, please enter the year which you would like to start studying at MIT.

27 What is the highest level of achievement you hold from a secondary school? You may tick only one
box. Your highest achievement may be a “traditional” award such as School Certificate, or you may have
achieved 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. Please note that
University Entrance attained from 2014 onwards is higher than NCEA Level 3.

 No formal secondary school qualifications  14 or more credits at any level

 NCEA Level 1 or School Certificate  Overseas Qualification (including International
Baccalaureate and Cambridge exams)
 NCEA Level 2 or 6th Form Certificate
 Other
 NCEA Level 3 or Bursary or Scholarship
 Not known
 University Entrance
If ‘Other’ or ‘Overseas Qualification’:

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 PAYMENT OF FEES

Fees should be paid in full or arrangements made for payment at the time of enrolment or by the start of the
programme.
- Confirmation of Enrolment will be provided in the form of a Statement of Fees.
- Depending on the programme taken, fees charged will be one or several of:
- Course tuition fee(s)
- Student services fee(s)
- Examination fee(s)
- NZQA registration and unit standard fees
- Other approved fees.
If paying by Student Loan, please call StudyLink for advice BEFORE the start of your programme/course on 0800 88
99 00.
PAYMENT OPTIONS
- Students who have not paid all their fees will not be eligible to receive course results or be able to enrol in any
other programme at MIT.
- StudyLink: To apply for a student loan to pay for your tuition fees, contact StudyLink on Freephone 0800 88 99 00
or online at www.studylink.govt.nz.
o NOTE: you are still liable for the payment of the remainder of the fees. Contact StudyLink on 0800 88 99
00 if you wish to pay the remainder of the fees by student loan.
- Direct credit or internet banking: Bank details are ANZ Bank A/C 06-0293-0073560-00. Please use your Student
ID number, name and (if applicable) company ID number as payment references.
- Online through the Learner Portal
- Cheques: Please make payable to Manukau Institute of Technology and mark “Not Transferable”. Write the
student’s name, Student ID number (if known), address and programme or course name on the back of the
cheque.
- Post: Our Mailing address is FREEPOST 73362 C/- Information and Application Centre, Manukau Institute of
Technology, Private Bag 94006, Manukau 2241, Auckland.
- Instalments: Domestic students who do not qualify for a student loan may be eligible to pay by instalments. All
cases are subject to the approval of the Academic Registrar by application, and if accepted will incur a $75
administration fee. International Students should contact the MIT International Centre.
- Training Incentive Allowance: If you have made arrangements to pay part of your fee by TIA, please provide the
WINZ approval letter to the Faculty/School where you are enrolled.
Company payment: If fees are being paid by a company, please pay by company cheque, OR provide a company
order form OR authorisation on company letterhead.

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 PRIVACY POLICY

Before you sign your acceptance, please read Manukau Institute of Technology’s privacy policy.
PERSONAL INFORMATION PRIVACY ACT 1993
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, image, postal and email
addresses, 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 under the
Education Act 1989 and other legislation relating to maintenance of official records and accountability for public
funding. 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 maintain 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 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.
Government agencies that may be supplied with data collected from your enrolment include:
- the Ministry of Education;
- the New Zealand Qualifications Authority;
- the Tertiary Education Commission;
- the Ministry of Social Development in relation to student loans and allowances; and
- Immigration New Zealand (a branch of the Ministry of Business, Innovation and Employment), for those who are
not New Zealand citizens or permanent residents.
When required by law, MIT releases information to government agencies such as the New Zealand Police,
Department of Justice, Ministry of Social Development and the Accident Compensation Corporation (ACC).
You have the right to request access to, and (if necessary) correction of, your personal information held by MIT.

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 DECLARATION

By submitting an enrolment, you agree to the following:

- I have read and accept the Privacy and Policy statements on this form.
- 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 declare that the information provided by me on this form is true and correct.
- I agree to abide by all MIT statutes, regulations and policies as may be amended from time to time. (Copies are
available at MIT’s library and 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 understand that MIT may need to validate my citizenship and visa status.
- I acknowledge that all MIT courses and programmes will proceed subject to enrolment numbers and MIT has the
right to cancel 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. I acknowledge that I am subject
to MIT policies concerning withdrawal from any courses and associated refunds (if any).
- 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
MIT may need to validate the information provided on this form and attachments.
- I authorise MIT to collect information for this purpose from any agency holding the source of this information.

Applicant signature Date

WHEN YOU’VE COMPLETED THIS FORM

Please return it to us at our Information and Application Centre or you can post it for free to us at:

FREEPOST 73362, C/- Information and Application Centre,

Manukau Institute of Technology,
Private Bag 94006, Manukau 2241, Auckland, New Zealand

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