Admission & Enrolment Form: Thank You For Applying To CPIT
Admission & Enrolment Form: Thank You For Applying To CPIT
Admission & Enrolment Form: Thank You For Applying To CPIT
Section 1 Tips
1 Your name and details
> Please only use a blue or Title Miss Mrs Ms Mr Other (please specify)
black pen
a
> Please print your legal Surname or family name
name in full. If you are not
commonly called by your a
legal name please fill in a Given name(s)
preferred given name
a
Preferred given name
> A verified copy of
your birth certificate
or passport needs to Have you previously been known by another name:
be provided with this
aa
form (see Section 10 for Previous family name(s)
details)
> If you have enrolled at aa
CPIT before you will have Previous given name(s)
a Student ID number and
if you have studied in
NZ you may have an NSI Gender Female Male Date of Birth d d/mm/y yyy
or NZQA number. If not
applicable enter N/A Have you previously been enrolled at CPIT? Yes No
a a
CPIT Student ID? NSI or NZQA No. (if known)
aa
Citizenship (Nationality)
Programme name
and specialisation or
> If you dont know your stream (if applicable)
start date please enter
the intended month you
will start your study Programme code
a
Level
a
Study start date d d/mm/yyyy
Will you be studying Full time Part time
Section 3 Tips
3 Your eligibility to meet entry requirements
A) Please select one of the following to demonstrate how you will meet the entry requirements:
I have provided evidence (attached) to show how I am meeting entry requirements
> Refer to CPIT brochures
or www.cpit.ac.nz I have provided evidence (attached) which shows I believe I meet the academic, English or other entry
for specific entry requirements with alternative evidence (eg work experience, other study or training)
requirements related to
your chosen programme I am still studying to meet the entry requirements
of study
I need to discuss my entry requirements into the programme (please specify below)
> Please attach:
a) verified copies of any
relevant secondary or
tertiary results to I am seeking special entry consideration (please specify below)
support this application a
b) Additional supporting
documentation such as
CV, referee statements,
portfolio, etc B) English language requirements: Is English your first language? Yes No
* See Section 10 for detail
of evidence required. a
If NO, specify language
and attach verified* copies of any English testing (eg IELTS, TOEFL) you may have
Section 4 Tips
4 Your contact details
Current/prior to study
Please provide your: Street address a
> Residential home address
before studying at CPIT a
Suburb
> Your residential term
a a
address while studying Town/City Postcode
at CPIT (if different from
above)
a
Suburb
a a
Town/City Postcode
Emergency contact
Full name a
a a
Phone Relationship to you
Section 5 Tips
5 Your ethnicity
This information regarding your educational background is required by the Ministry of Education.
A) SECONDARY EDUCATION
> Please note: educational a
Name of last school attended
institutes are required to
report statistical information
to the Ministry of Education What years did you attend this school?
yyyy to
yyyy
on an annual basis
What is the highest level of achievement you hold from a secondary school? Please tick one box only
B) TERTIARY EDUCATION
Will this be your first year of tertiary study? Yes No
a
If NO, please enter the name of the tertiary institute you last studied at:
a
If NO, what qualification were you studying toward?
If NO, what year was your first year of tertiary study? yyyy
C) PRIOR ACTIVITY
What was your main activity/occupation in New Zealand on 1 October prior to the date of your programme starting?
Section 7 Tips
7 Your learning support
Do you live with the effects of an injury, long-term illness or impairment? Yes No
This information will If YES, please indicate your condition/disability by ticking the boxes that apply to you:
remain confidential. It
enables us to discuss with Deaf/Hearing Impairment Blind/Vision Impairment Speech
you the most appropriate
learning support to meet Mobility Dyslexia Specific learning disorder
your specific individual
a
needs. Medical (please specify)
Section 8 Tips
8 Your feedback is appreciated
How did you hear about the programme you are applying for?
Advertising In Person Events
This information will help
us to understand and CPIT website School visit CPIT Open Day
communicate more easily
with potential students. Internet search Careers Advisor CPIT information session
CPIT would like to contact Social media eg Facebook, Twitter An industry contact Have a Go Day
you with information
TV CPIT staff Careers Expo
about events and
activities. Radio Family Industry Expo
Print: newspaper, magazine
Outdoor: billboard, bus back, poster
Other (please specify)
Organisation/Company Paying
Please attach a letter from the organisation/company paying your fees to that effect. If for any reason the
organisation/company does not pay your fees you are still liable and must pay all fees yourself.
a
Organisation/Company Name
a
Authorised Contact Person
a
Postal Address
Telephone Number
Letter or purchase order number attached from company/organisation confirming payment of fees
(as above)
Section 10 Tips
10 Your checklist
Have you completed the following:
>*A verified copy is a Read the Admissions & Enrolment Guide and understood the terms and conditions of your admission and
photocopy of your enrolment (www.cpit.ac.nz/enrol)
original document,
signed as being a true Completed all required sections of this Admissions & Enrolment form
and accurate copy by
one of the positions Read, signed and dated the Acknowledgement and Declaration (Section 11)
listed below.
Justice of the Peace Attached a verified* copy of your birth certificate or passport proving your identity, plus
(see Yellow Pages) permanent residency, visa and change of legal name certificate (eg marriage certificate)
Solicitor
Registrar or Deputy
Attached any additional documentation required to support your application such as
Registrar of the Courts
CPIT Admissions
your academic record, CV, police check, health declaration, references, portfolio requirements, etc
& Enrolments staff
member Attached a copy of your highest academic achievement or equivalent at secondary school
(eg NZQA Record of Learning or other Tertiary Institution Academic Transcript)
The following needs to be
included on the copy to be Completed the fees details, and understood you must pay all fees in full prior to the start
considered a verified copy: of your programme or CPIT reserves the right to cancel your enrolment
the words original
sighted Kept a photocopy of this Admission & Enrolment form for your records
name and signature
of person sighting the
original document
institution/organisation
stamp or handwritten
institution/organisation
name
Section 11 Tips 11 Your acknowledgement and declaration
I hereby apply for admission and enrolment at CPIT and I understand and agree to the following:
> Please read and then a) as soon as CPIT receives my Admission & Enrolment form and proof of my identity, I have a conditional
sign and date below contract to study at CPIT. I can only withdraw from that contract by CPIT receiving a signed completed CPIT
Enrolment Amendment Form as set out in the Admission & Enrolment Form and Guide.
c) CPIT reserves the right to cancel any course at any time fees and charges paid will be refunded in full to the
person or organisation which paid originally, or may be transferred with the agreement of the original payee
and used as payment towards another course
d) CPIT reserves the right to alter any aspect of any course at any time. Where days, dates or times are altered,
CPIT undertakes to attempt to contact all enrolled students, either at their stated address or contact number
to inform them of such changes
e) that if I receive a CPIT letter confirming my enrolment, I will (subject to my right to withdraw as set out in this
Admission & Enrolment Form and in the Guide) participate in the qualification/courses I am enrolled in and
use my best efforts to successfully complete the qualification/courses
f) that the information I have given CPIT is true, and complete in all respects
> You can read the
g) that I have read and understand the CPIT Policies Personal Information & Privacy Principles as set out in
Terms & Conditions of
Enrolment at the Admission & Enrolment Guide. This sets out the circumstances under which CPIT may use/disclose my
www.cpit.ac.nz/ personal information.
terms-and-conditions h) that I have read and understand the CPIT Student Rights and Responsibilities as set out in the Admission &
Enrolment Guide.
i) that I have read and understand the terms of my conditional admission and conditional enrolment at CPIT
and, if confirmed, terms of my enrolment as set out in the CPIT Admission & Enrolment Guide and this
Admission & Enrolment Form
j) I acknowledge that any information collected by the Literacy and Numeracy assessment tool may be used by
CPIT to measure and report on CPITs performance
k) that I have read, I understand and I agree to the Acknowledgement and Declaration section of the Admission
& Enrolment Form
Signature
of parent/guardian Date d d/mm/y yyy
If the applicant is under
18 years of age at the date
they are due to commence study
CPIT Student ID
a
Given name(s)
a
American Express
Master Card
Visa
a
Expiry date
a
Amount
a
Course code/s
INTERNET BANKING
Date received a
a
Staff member