2017 APPLICATION FOR ADMISSION – INTERNATIONAL STUDENTS
Return to: The RegistrarPO Box 12747 Penrose
Auckland 1642
New Zealand / Phone: +64 9 580 1500
Fax: + 64 9 579 5150 Email:
Web: www.acnz.ac.nz
Physical address: 60 Rockfield Road, Penrose, Auckland 1061, New Zealand
Welcome to Alphacrucis!
Please read the instructions below carefully before you complete this application form.
INSTRUCTIONS
The purpose of this application form is to obtain from you the information we need to admit you into a qualification at our organisation. We also need to collect information from you which is required by the Ministry of Education and other Government agencies for statistical and registration reasons.
A QUALIFICATION
1 / What qualification do you intend to enrol in (please tick one):
Christian Studies:
Diploma in Christian Ministries (Level 5)
Diploma in Christian Ministry Development (L6)
Bachelor of Contemporary Ministry (Level 7)
When do you wish to begin your study?
Semester 1 2017
Semester 2 2017 / English Language Studies:
NZ Certificate in English Language (L2) (20 Weeks)
NZ Certificate in English Language (L3) (20 Weeks)
NZ Certificate in English Language (L4) (20 Weeks)
Intensive Literacy and Numeracy
General /Academic English Short Courses
(number of weeks: )
What date do you wish to begin your study? ______
Business Studies
NZ Diploma in Business (Level 6)
When do you wish to begin your study?
Feb 2017
Jul 2017
2 / Have you studied at this college before? Yes No / If you answered “yes”, what was your Student ID number?
3 / Do you intend to study: Full time OR Part time / How did you hear about the College?
AC Website AC Student
AC Staff Church
Word of mouth Direct Mail
Conference Advertising
Email Radio
Newspaper Magazine
Other
B PERSONAL DETAILS (all fields compulsory)
4 / Preferred title: / Ms / Miss / Mrs / Mr / Other (Specify):
5 / Given Name(s):
Family Name:
Preferred first name:
Previous name(s) known by: / If you have previously enrolled at this organisation under another name, what was that name?
6 / Date of birth: / 19
day month year / Gender: / Male / Female
7 / If you know your NSN (National Student Number) please write it here: / --
8 / Home Address / Street Address:
Suburb: / Town/City:
Country: / Post Code:
9 / Postal Address (if different from above) / Street Address:
Suburb: / Town/City:
Country: / Post Code:
10 / Contact Details / Phone:
Mobile: / Email:
11 / Secondary School: / What was your last year at secondary school?
12 / Tertiary Study: / Will this be the first year you have ever enrolled in a University, Polytechnic, College of Education, Private Training Establishment, or Wananga either in New Zealand or overseas since leaving school? Do not include enrolments in STAR, community or hobby classes.
No Yes
If you answered “No”, please enter the name of the qualification, the organisation you studied at, and the year of your first enrolment:
Name:
The year of your first enrolment:
Year: Completed
What year do you expect to complete the academic requirements of your course/s at Alphacrucis in order to graduate with your qualification?
Year:
13 / English Proficiency / Is English your first language? No* Yes
*If English is not your first language, you may be required to complete an English
Proficiency Test.
If you have completed an English Proficiency Test please include a certified copy of the Test results.
Name of English Language Test completed:
Test Date (dd/mm/yyyy): __ __ / __ __ / ______
Test scores:
14 / Citizenship and Residency:
You will need to supply evidence of citizenship / Please specify your country of citizenship:
______
(For students with dual citizenship, specify the country of citizenship of the passport used to enter New Zealand.)
15 / Ethnicity:
What ethnic group(s) do you belong to?
You may tick up to three boxes, which apply to you. / NZ European/Pakeha 111 Polish 124 Indian 431
New Zealand Māori 211 South Slav 125 Sri Lankan 441
Samoan 311 Italian 126 Japanese 442
Cook Island Māori 321 German 127 Korean 443
Tongan 331 Australian 128 Other Asian 444
Niue 341 Other European 129 Middle Eastern 511
Fijian 361 Filipino 411 Latin American 521
Other Pacific Peoples 371 Cambodian 412 African 531
British/Irish 121 Vietnamese 413 Tokelauen 351
Dutch 122 Other Southeast Asian 414 Other 611
Greek 123 Chinese 421 Not Stated 999
Please specify if “Other Pacific Peoples”, “Other European”, “Other Southeast Asian”, "Other Asian" or "Other”.
16 / [1]Disability:
Do you live with the effects of significant injury, long term illness, or disability? The information you supply is confidential.
If yes, how would you describe your impairment, disability or long term medical condition:
The completion of this section is not compulsory / Yes / No
17 / Next of kin details / Name:
Relationship to You: / Phone:
Address: / Email:
C PAYMENT DETAILS
18 / Please note below your preferred method of payment
Cash
Credit Card
Direct Credit
EFTPOS
19 / Cross Credit, Credit Transfer & RPL / Do you wish to apply for cross credit, credit transfer or RPL?
Yes* No
*If yes, please attach relevant certified copies of transcripts and/or supporting documents with your completed ‘Application for Credit’ form
D INTERNATIONAL STUDENT INFORMATION
20 / If you are going to organise your own accommodation in New Zealand, please provide us with your address while studying here. / Street Address:
Suburb:
Town/City: / Post Code:
21 / Name of Agent (if applicable)
22 / Passport Details / Passport Number:
Passport Expiry Date:
Passport Country:
23 / Visa Details / Visa Type (if known):
Visa Expiry Date (if known):
24 / Do you need airport pick up on arrival to New Zealand? No Yes
Please refer to the Application Guide or Website for airport pick-up charges. If you tick ‘yes’, please provide us with flight details once they are confirmed.
25 / International students are required by Immigration NZ and the Ministry of Education to hold valid travel and medical insurance during their stay in New Zealand.
Do you need the College to organise medical insurance for you? No Yes
Please contact the Admissions Office for details and costs.
26 / If you need us to organise homestay accommodation for you, please answer the following questions:
Please refer to the Application Guide or Website for homestay fee and charges. Fees are charged weekly. / Expected start date of homestay required: / / (DD/MM/YYYY)
Expected finish date of homestay required: / / (DD/MM/YYYY)
Do you prefer to stay with a family:
with young children younger couple with no children
with older children older couple with no children at home
with no pets (cats/dogs) I have no preference
Do you smoke cigarettes? no yes
Would you live with a family who smoke? no yes
Please specify any health problems / allergies you may have: / Please specify any foods that you cannot eat:
What is your religion (if any)? / What are your hobbies/interests?
E DOCUMENTATION
27 / Please indicate that you have filled in the form properly by ticking off each of the following before you send this in to the College. If these boxes are not ticked, the application will not be processed until this information is provided:
All sections of the form are complete
Method of payment is complete
All documentation required is attached
Attested copy or passport
Application fee provided
Form Signed (see below)
DECLARATION
Privacy – The College collects and stores information from this form to:
· manage the business of the College (including internal reporting, administrative processes and selection of scholarship and prize winners)
· comply with the requirements of the Education Act 1989 and other legislation[2] relating to maintenance of records
· supply information to government agencies and other organisations as set out below.
In signing this application form you authorise such disclosure on the understanding that the College will observe the general conditions governing the release of information, as set out in the Privacy Act 1993, the Education Act 1989, and the Post-compulsory Unique Identifier Code of Practice. You may see any information held about you and amend any errors in that information. To do so, contact the Registrar.
NB: The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires the College to collect, hold, handle, use and disclose personal information in accordance with the twelve information privacy principles in the Act. http://www.privacy.org.nz
Supply of information to government agencies and other organisations:
The College supplies data collected on this form to government agencies to comply with the requirements of the Ministry of Education (student statistical returns), New Zealand Qualifications Authority (Record of Learning registration and Unit Standard outcomes), Tertiary Education Commission (funding returns), Industry Training Organisations (funding and academic outcomes), Ministry of Social Development (confirmation of enrolment and academic outcomes), Inland Revenue Department (student loan interest rebate), Department of Immigration (if you are not a New Zealand citizen or permanent resident) and Agencies who support particular students through scholarships and prizes, payment of fees or other awards (if you are a recipient of one of these awards).
Your personal details (name, date of birth and residency) as entered on this form will be included in the National Student Index and may be used in an authorised information matching programme with the New Zealand Birth Register.
The government agencies above may supply data collected on this form to Statistics New Zealand for the purposes of integrating data with data collected by other government agencies, subject to the provisions of the Statistics Act 1975. Integrated data is used for the production of official statistics, to inform policy advice to government and for research purposes.
In handling data supplied by you on this form, the government agencies are required to comply with the provisions of the Privacy Act 1993.
In addition, when required by statute, the Institute releases information to Government agencies such as the New Zealand Police, Department of Justice, Ministry of Social Development, the Accident Compensation Corporation (ACC) and the NZ Immigration Services.
The information is also used to select students for qualifications, to manage internal administrative processes, and for internal reporting. Information about students may be supplied to, and sought from, other educational organisations for the purpose of verifying academic records.
Fees – In signing this application form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery. The College’s policy on withdrawal and refund of fees may be obtained from the Registrar.
Rules – In signing this application form you undertake to comply with the published rules and policies of the College with regard to attendance, academic progress, standard of dress, health and safety, and behaviour.
Declaration of Conflict of Interest - In accordance with NZQA rules, Alphacrucis requires all directors, Council members and senior staff to make a declaration regarding any conflict of interest they may have due to involvement with other organisations. The declaration is fully detailed on the website at www.acnz.ac.nz/conflict of interest. In signing this enrolment form I acknowledge that this information is available to me.
Declaration – I declare that to the best of my knowledge all the information supplied on, and with, this application form is true and complete, I agree to abide by the conditions described above, and I consent to the disclosure of personal information as described above.
______/______/______
Signature Date
Ø Please make sure that you sign your application form above ×
2014 application form- International Students v 2
[1]
[2] This includes legislation governing the maintenance of official records and for accountability for public funding.