Domestic Application Form

NZSE College Domestic Application Form - School of ATC

The purpose of this application form is to obtain from you the information we need to enrol you into NZSE College. We are required to collect information from you which is required by the Ministry of Education and other Government agencies for statistical and registration reasons. Please note: NZSE College is a state-funded tertiary provider. All sections of this form must be completed. Until this form is fully completed, and the necessary documentation provided we are not able to process your application. If you have any questions, please do not hesitate to ask. Please ensure you have the following documents ready to be uploaded if you wish to streamline the application process. Otherwise please contact us if you need any assistance at 0800 99 88 11.
Select your Programme / Course*

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
How would you like to attend your sessions?

Face to FaceBlended

Applicant Information

Please note: If applicant is under 18 years of age, the application must be signed by the parent/guardian and all correspondence regarding your application will be forwarded to your education agent and/or to your parent/guardian.
Are you over 18 years of age?*

YesNo
Basic Details

Please make sure keep a legal ID handy, and fill the form with your legal names, double check the date of birth and other relevant fields.
First Name(s):*
Middle Name(s):
Last Name:*
Preferred Name(s):
Your Date of Birth*

DayMonthYear
Date
Preferred Title*
Gender*

Contact Details

Please make sure you enter your legal name and date of birth which matches your ID.
Email*
example@example.com
Mobile Phone*

Pre-FixPhone Number
Secondary Phone

Pre-FixPhone Number
Address*
Mailing Address Line 1
Suburb*
City*
Postal/Zip Code*
Country*
Citizenship and Residency

To qualify as domestic student, you must be a New Zealand citizen (including students from the Cook Islands, Tokelau or Niue who have New Zealand citizenship) OR hold a resident visa, permanent resident of New Zealand OR a permanent resident of Australia residing in New Zealand.
Citizenship Status*
Citizenship*
Country of Birth*
Ethnicity*
Second Ethnicity
Third Ethnicity
If you identified as New Zealand Māori, with which Iwi do you identify?*

Emergency Contact Details (Next of kin)

A staff member may contact the nominated emergency contact, in relation to the applicant’s wellbeing and safety: (a) should there be an uninformed absence of over three days (b) a medical emergency, or (c) reasonable grounds for believing that the disclosure is necessary to prevent or lessen a serious threat to the student’s life or health.
First Name*
Last Name*
Relationship to applicant*
Emergency Contact Mobile Number*

Area CodePhone Number
Emergency Contact Email
example@example.com
Youth Provider Details (if applicable)

A staff member may contact the nominated contact, in relation to the applicant’s wellbeing and safety: (a) should there be an uninformed absence of over three days (b) a medical emergency, or (c) reasonable grounds for believing that the disclosure is necessary to prevent or lessen a serious threat to the student’s life or health.
First Name
Last Name
Organisation Name
Contact Mobile Number

Area CodePhone Number
Emergency Contact Email
example@example.com

Academic Background
Role prior to application (Previous year)*
Name of Last High School Attended*
Last Year of High School*
What is the highest level of achievement you hold from a high school*
Is this the first year you have enrolled in a tertiary provider since leaving school?*

YesNo
If you answered “No”, please enter the name of the organisation and Programme you studied at and the Year of your First Enrolment:
Name of the Organisation
Programme Name
Year of First Enrolment

Disabilities/Health

This information is confidential to NZSE College but it could be used by the Student Advisors to obtain further resources and support that will assist you in your studies.
Do you have a disability and/or medical condition (this could include both diagnosed and non-diagnosed health conditions? (NOTE: This information will remain confidential).*

YesNoPrefer not to say
If "Yes" is answered, please select all that apply regarding your disability/or medical condition (NOTE: This information will remain confidential):*
Do you have any medical condition (including allergies) that may require the school to provide assistance? (NOTE: This information will remain confidential).

YesNo
If "Yes", please outline your needs:
Are you taking any medication for your illness/disability? If so, please state:

School of ATC Military Prep Physical Activity Statement

For school of ATC Military Prep, Security and Uniformed Services students.
I understand that physical activities provide an opportunity for me to learn, practice skills, gain attitudes and values as part of my learning journey with ATC.

I agree to inform ATC as soon as possible of any changes to my medical status or other circumstances.

I agree to myself receiving any emergency medical, dental, or surgical treatment, including anaesthetic or blood transfusion, as considered necessary by the medical authorities present.

I agree that any medical costs not covered by ACC or a community services card will be paid by me.

I understand that the following activities are part of my learning experience at ATC:
- Running
- Jumping
- Sit-ups
- Crunches
- Climbing
- Crawling
- Squats
- Beep tests
- Press-ups
- Corrective training
- Leaping
- Stretching body parts
- Star jumps
- Hiking in bush or forest areas
- People pyramids
- Exercise circuits
I also understand that there is a risk of injury when participating in these activities*. To avoid injury, I am required to take on genuine responsibility for my own learning and safety as well as that of others, by following the instructions and participate safely to meet the requirements of the programme.

*Activities that may take place outside of the campus: Water activities - Swimming, Kayaking, Rafting, Sporting activities - Touch, Tag, Basketball, Volleyball, Lifting heavy equipment - Tyres, Logs, Weight and People, Team building activities - Trust exercises that involve blindfolds, trust falls, etc., LEVEL 1 ONLY - Low Rope and High Rope activities/courses, LEVEL 2 ONLY - Shooting Range activities (using firearms under strict supervision).
I have read, understood and agree to the above ATC Military Prep Physical Activity Statement and I declare that:*

I acceptI decline

Travel Allowance Declaration

Only fill in this section if you need to apply for travel allowance. Please note that travel allowance is only eligible for Youth Gurantee learners.
Are you applying for Travel Allowance? (Only eligible with Youth Guarantee)*

YesNo
How do you travel to NZSE College/ATC?*

Public TransportPersonal Transport
Please attach a 2-way (RETURN) Transport Ticket:

Cancelof
IFull Name field. will be driving a personal vehicle to the course each day. The total distance isDistance (km) KMs return.
Please attach a copy of your Driver's License:

Cancelof
Please attach a picture of the map showing the distance travelled (i.e. Google Maps):

Cancelof
Bank Account Details:*
Please attach a stamped copy of Bank Account Details:

Cancelof
I hereby confirm that the above stated by me is true and accurate to the best of my knowledge.

YesNo

File Upload

Please upload the correct files listed below (fields marked with an * are required). Please ensure files are named appropriately before uploading.
Upload Certified Copy of Citizenship/Residency Evidence Document:

A certified copy means a photocopy of your original document, signed as being a true and accurate copy by a Justice of the Peace, Solicitor, Minister of the Church, General Practitioner or School Principal. Otherwise, our NZSE College Recruitment Consultant will photocopy all originals and verify the copies.
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ID Upload

if your photo is not verified by a Justice of Peace (JP), you will need to have this sighted and stamped by a JP and emailed to domestic.recruit@nzse.ac.nz OR taken into one of our campuses
Please tick which document(s) you will attach to your form (Please attach on the File Upload page):*

Birth CertificateNew Zealand PassportCertificate of Citizenship or Letter of ConfirmationOverseas Passport with ResidencyA Statement of Whakapapa including date of birth, countersigned by Kaumatua
Please upload a copy of your Birth Certificate:

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Please upload a copy of your New Zealand Passport:

Cancelof
Please upload a copy of your Certificate of Citizenship or Letter of Confirmation:

Cancelof
Please upload a copy of your Overseas Passport with Residency:

Cancelof
Please upload a copy of your Statement of Whakapapa including date of birth, countersigned by Kaumatua:

Cancelof
Employment/Job References Upload

Please upload your Employment/Job References
Employment/Job References:

Cancelof
Student ID Photo

Click the "take photo" button below to take a selfie of yourself, and we will use this as your school photo ID. Please make sure your facial features must be visible.
How would you like to pay?*

I pay now onlineI pay on siteI need assistance, please contact me

Terms and Conditions
Please review our Terms and Conditions to understand your rights regarding your personal information, and acknowledge it by ticking the box below.
I have read the Terms and Conditions?*

Yes
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 above, and I consent to the disclosure of personal information as described above. I give NZSE College consent to access prior learning records through my NSN number and literacy and numeracy results through TEC.*

I acceptI decline
Applicant Signature (if over 18 years old)*

Clear
Date

DayMonthYear
Date
Parent/Guardian Signature (If student is under 18 years old)

Clear
Parent/Guardian: Please attach a copy of Photo ID (e.g. Passport, Driver's License)

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Should be Empty:

NZSE College Domestic Application Form - School of ATC

Applicant Information

Basic Details

Contact Details

Citizenship and Residency

Emergency Contact Details (Next of kin)

Youth Provider Details (if applicable)

Academic Background

Disabilities/Health

Declaration

Immunisation Declaration

Criminal Record Declaration

Image Disclaimer

Device Declaration

Authorisation to contact Employer

School of ATC Military Prep Physical Activity Statement

Travel Allowance Declaration

File Upload

ID Upload

Employment/Job References Upload

Student ID Photo

Terms and Conditions