VHNZ Short Course Enrolment Form

Standard Enrolment Form

Enrol into one of our exciting courses
For New Zealand Applicants Only
By sending this form and clicking the option "Start Application”, I, as the Data Subject, hereby consent to the processing of my provided personal data for the purpose of application and enrolment into our advertised programme and courses.
Select your Programme / Course*

Standard Enrolment Form

Enrol into one of our exciting courses
By sending this form and clicking the option "Start Application”, I, as the Data Subject, hereby consent to the processing of my provided personal data for the purpose of application and enrolment into our advertised programme and courses.
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Selected Programme (hidden)
Total

Your Contact Details

Please provide us with your contact details
Title
Your First Name*
Your Middle Name
Your Surname*
Phone Number*

Pre-FixPhone Number
Email*
example@example.com
Your Date of Birth*

DayMonthYear
Date
Your Gender*
Gender
Take a Photo for your Account

Contact Continued

Please provide us with your contact details
Your Address*

Street Address

Street Address Line 2

CityRegion

Post CodeCountry
Do you live with the effects of significant injury, long term illness, or disability?*

YesNo
Do you access a disability service?*
Please provide details about your injury, long term illness, or disability
Drivers License Number
This is not required other than endorsements
Workplace
Workplace Name
Workplace Postal Address
Workplace Town/City
Workplace Email
Workplace Phone

Emergency Contact

In case of an emergency, who shall we contact?
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation*
Phone Number*

Pre-FixPhone Number
Email
example@example.com

Study in New Zealand

The NZ Government wants to know a few more things about you
What is your Country of Birth?
What is your NZ residency status?
What is your current NZ visa?
Citizenship*
NSN Number (Optional)
This is the New Zealand Student Number. This is an optional field, please only fill it in if you know your NSN.
You can identify with up to three ethnicities, please select at least one below
Ethnicity 1*
Ethnicity 2
Ethnicity 3
If you have selected Maori at least once in above selection, you can affiliate with up to three IWI's
IWI 1*
IWI 2
IWI 3
Your Documents

Please upload an identity document and proof of your achievements
Please select an identity document
How would you like to submit your identity document*

Upload a copy of my identity documentTake a picture of my identity document
Upload your identity document*

Please upload all transcripts and diplomas of previous achievements
Cancelof
Capture the identity page of your Passport*
Capture your Birth Certificate*
Picture side of Drivers License*
Back side of Drivers License*

Declaration
I declare that the information provided by me is accurate and complete.

I understand that failure to disclose required information or the supply of incorrect information may result in my enrolment not being processed, or my enrolment being cancelled.

I understand that the purpose of collecting this information is to allow VHNZ to carry out the functions required of them as a tertiary education provider and to make my training record available to customers and employer to validate the currency of my training.

I authorise VHNZ to disclose this information, when required, to relevant agencies including but not limited to Government agencies and tertiary providers and when required by law.

I understand that VHNZ will release information to other Government agencies such as the New Zealand Police, WorkSafe New Zealand, Department of Justice, Ministry of Social Development, Inland Revenue, and the Accident Compensation Corporation.

I authorise VHNZ to disclose my information to the above agencies on the understanding that VHNZ will observe the general conditions governing the collection, use, storage and disclosure of personal information under the Privacy Act 2020 and Education and Training Act 2020.

I understand that I may view any information that VHNZ holds about me at any time and amend any errors in that information, by contacting the Chief Operating Officer at VHNZ, PO Box 15030, Tauranga 3144 or emailing info@verticalhorizonz.co.nz

I consent to receiving electronic messages from VHNZ in relation to goods, services and facilities that are available to me.

I understand that my employer, and/or the person or organisation who funded this course, may copy and view this material to check my attendance, record of training, and my or VHNZ performance.

I agree that VHNZ may use material collected during this course for future training and marketing purposes. I understand my name will not be associated with any of this material without a separate agreement.

Ok you made it

Please sign off your application
How did you hear about us?
Signature*

Clear
Math Challenge
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Standard Enrolment Form

For New Zealand Applicants Only

Standard Enrolment Form

Your Contact Details

Contact Continued

Additional Learner Needs

Emergency Contact

Study in New Zealand

Your Documents

Declaration

Ok you made it