official use only - id number

short course application form

who should complete this form?
Applicants for Compact Courses Applicants for Short Courses (courses that do not have academic credit) Applicants for Certificates of Personal Interest Applicants for courses that have academic credit Existing AUT University students or those that have studied here before (you can apply over the phone please contact the Student Information Centre on 09 921 9779)
The easiest way to apply is to call us on (09) 921 9779 and have your credit card details ready.

barcode here

section three
3.1

citizenship
New Zealand permanent resident International student

Please tick one of the boxes below that applies to you: New Zealand citizen Refugee status

who should not complete this form?

Australian citizen or permanent resident If you are a NZ permanent resident or International student or have refugee status, please give country of citizenship:

stop save time section one

1.1 1.2

3.2

personal details
Mr Ms Mrs Miss Other

section four
4.1

ethnicity

Title

Surname or family name (as appears on your passport, birth certificate, marriage or civil union certificate) First name(s) Preferred first name

The following information is required by the Ministry of Education and other authorised agencies as part of your enrolment. Please indicate which ethnic group(s) you belong to New Zealand European/Pkeh Samoan Tongan New Zealand Mori Cook Island Mori Niuean Fijian Dutch Middle Eastern South Slav German Filipino African Chinese Indian Japanese Latin American Other

1.3 1.4

Tokolauan British/Irish Greek Polish Italian

1.5 1.6 1.7

Date of birth Gender Male Female

Please provide your NSI/NZQA identification number. If unknown, please leave blank:

Australian Cambodian Vietnamese

section two
2.1

contact details

Please note: This will be used to post all correspondence to. Please ensure this is kept up-to-date at all times and advise us if it changes.

What is your main contact address?

Other Southeast Asian Sri Lankan Korean Not stated

2.2 2.3 2.4

Street number and name Suburb

City/Town

Other Pacific Peoples - please state here: Other Asian - please state here

2.5 2.6 2.7 2.8 2.9 2.10 2.11 2.12 2.13

Post code Telephone Mobile Work

( ( ( ) ) )

4.2

If you are of Mori descent, please state the Iwi with which you have the strongest affiliation:

section five
5.1

course selection

Email: What is your alternative contact address? Street number and name Suburb Post code

Please specify which short course you are applying for at AUT University in order of preference. Programme and paper codes can be found by visiting our website at: www.aut.ac.nz

course name: paper code: fee: course name: paper code: programme code: start date: programme code: start date:

City/Town

2.14 2.15 2.16 2.17

Emergency contact Name Relationship to you Telephone

( )

fee: course name: paper code:

programme code: start date:

fee:

section six
6.1

statistical information

section eight

method of payment

Why did you decide to study at AUT University (please tick one) AUT Universitys reputation in your chosen programme(s) AUT Universitys reputation as a university Information from a secondary school careers advisor Information from a family member or friend Information from an AUT University staff member Information from an employer Only AUT University offers your chosen programme AUT University is close to your home/location AUT University offered you study assistance (e.g. fees scholarship) Your application to study at another university was unsuccessful Other - please state:

Payment of course fees must accompany this form in order for us to process your application. 8.1 Please state the total course fees in the box below Course fee (GST included):

8.2

How do you intend to pay for your study? Cash Cheque NZ Income Support Company payment Please invoice my employer* Credit card - please fill out table below:

credit card payment credit card type credit card number: cardholders name: expiry date: cardholders signature: Visa MasterCard American Express

section seven disabled students and deaf students

This section is not compulsory, however information provided will help us improve our services. 13.1 Do you live with the effects of significant injury, long term illness, or disability? Yes No - please go to section eight

Payment is required in advance. If you would like to pay with your credit card via phone please call the Student Information Centre on (09) 921 9779 with your credit card details ready. Please do not post cash. Cash payments must be made in person at the Cashiers located at the Student Information Centres. Cash cannot be accepted after 3.30pm Cheques should be made payable to Auckland University of Technology and posted to AUT, Private Bag 92006, Auckland 1142 * Please provide a letter of guarantee or purchase order from your employer for the full amount of the fees specified. Valid travel and medical insurance is mandatory for international students and can be purchased from AUT University. Please contact the Student Information Centre for more information.

13.2

If yes, please indicate by ticking the appropriate box below. Deaf Blind Hearing impairment Vision impairment Medical Mental health Speech impairment

Specific learning disability Head Injury

Mobility/physical

Temporary impairment Other - please state:

for more information

If you need help or assistance in filling out this form, please contact the Student Information Centre. Our friendly staff will be able to assist you through the application process and help answer any queries you may have. Phone: Online: (09) 921 9779 www.aut.ac.nz/studentinfo

section nine
Your signature:

applicant signature
Date:

City Campus Level 2 (ground entry), WA Building 55 Wellesley Street East, Central City, Auckland opening hours MondayFriday*, 8.00am5.00pm Opening hours may be extended during February and July. Please check the website. North Shore Campus AG Building 90 Akoranga Drive Northcote, North Shore City opening hours MondayFriday, 8.00am4.30pm Manukau Campus MB Building 640 Great South Road Manukau City opening hours MondayFriday, 8.30am4.30pm

where to send this form

Please return this form to: Registry Services AUT University Private Bag 92006 Auckland 1142

* Remember the easiest way to apply is to call us on (09) 921 9779 and have your credit card details ready.