Enrolment Form Welcome to Exercise Academy @School of Business Ltd. Please read the instructions below carefully before you complete this enrolment form. INSTRUCTIONS The purpose of this enrolment form is to obtain from you the information we need to enrol you into a qualification at our organisation. We also need to collect information from you which is required by government agencies for statistical and registration reasons. Please fill in the form properly by: Completing all sections of the form. Attaching to the form additional documentation that is required for government funding purposes. A description of the required documentation is provided on page 6 of the form. A. QualificationI am applying for:*NZ Certificate in Exercise (Level 4) BLENDED (Online Classes)NZ Certificate in Exercise (Level 4) BLOCK ClassesQualification start date*20212022Qualification End Date (If Known)20212022Have you studied at School of Business Limited before?* Yes No Do you intend to study:* Part time Full time B. Personal DetailsFull Legal Name* Mr.Mrs.MissMs.Dr.Other Rev. Prefix First Middle Last Preferred first name First Previous name(s) known by:If you have previously enrolled at this organisation under another name, what was that name?Date of Birth* Day Month Year Gender* Male Female Diverse If you know your NSN (National Student Number), please enter it here. Citizenship and Residency: You may need to supply evidence of residence or citizenshipWhich best describes your citizenship?* New Zealand Citizen Australian Citizen Other Country of Citizenship* For students with dual citizenship, specify the country of citizenship of the passport used to enter New Zealand.Please specify your fee/assistance status:* Domestic Student* (00) NZAID Student (01) International Fee-Paying Student (including people on current work visa) (03) Student on a recognised exchange scheme (04) Foreign Research Based Post-Graduate** (06) Diplomatic staff or family, or persons associated with Antarctic Programme (08) International On-Shore PhD student (09) International student doing ITO off-job training (12) Refugee or protected person whose application for residence is being processed OR a person who has made a claim to be recognised as a refugee or protected person and holds a valid temporary visa (13) * Always use 00 for New Zealand Citizen; use 00 for New Zealand resident visa holder and Australian Citizen or Australian Permanent Resident residing in New Zealand during the time studying this qualification. ** Use 06 for a student enrolled in a programme of study that is: • A PhD (level 10 on the NZQF); and • Wholly research (for example, 120 point thesis) Use 03 for an international student enrolled in a programme of study that is a Masters (level 9 on the NZQF) or a Doctoral Programme, excluding PhDs (level 10 on the NZQF ).Do you have New Zealand or Australian Permanent Resident Status?* New Zealand Resident Visa Holder Australian Permanent Resident During your time studying in this qualification will you be resident in New Zealand or overseas?* in New Zealand overseas Ethnicity: What ethnic group(s) do you belong to? You may tick up to three boxes, which apply to you. Please select* NZ European/Pakeha (111) New Zealand Māori (211) Samoan (311) Cook Island Māori (321) Tongan (331) Niue (341) Tokelauen (351) Fijian (361) Other Pacific Peoples (371) British/Iris (121) Dutch (122) Greek (123) Polish (124) South Slav (125) Italian (126) German (127) Australian (128) Other European (129) Filipino (411) Cambodian (412) Vietnamese (413) Other Southeast Asian (414) Chinese (421) Indian (431) Sri Lankan (441) Japanese (442) Korean (443) Other Asian (444) Middle Eastern (511) Latin American (521) African (531) Other (611) Not Stated (999) Please Specify* If “Other Pacific Peoples”, “Other European”, “Other Southeast Asian”, "Other Asian" or "Other” please specify what specific ethnicity.What is the name of your Iwi?*You may enter more than one Iwi. If you do not know your Iwi, please enter 'Don't Know'. Iwi: Rohe (Iwi home area)*What was your MAIN activity or occupation in New Zealand at 1 October 2020?* Secondary school student (01) Non-employed or beneficiary (excluding retired) (02) Wage or salary worker (03) Self-employed (04) University student (05) Polytechnic student (06) House-person or retired (08) Overseas (irrespective of occupation) (09) Private Training Establishment student (11) Wānanga student (12) Do you live with the effects of significant injury, long term illness, or disability?The information you supply is confidential. The completion of this section is not compulsory Yes No How would you describe your impairment, disability or long term medical condition:C. ACADEMIC INFORMATIONWhat was the name of the last secondary school you attended? State “overseas”, if applicable.* What was your last year at secondary school?* What is the highest level of achievement you hold from a secondary school?*Your highest achievement may be a “traditional” award such as School Certificate, or you may have achieved a number of credits or a National Certificate at a certain level on the National Qualifications Framework. Your NZQA Record of Achievement shows you the standards, credits and qualifications you have achieved No formal secondary qualifications (00) 14 or more credits at any level (11) NCEA Level 1 or School Certificate (12) NCEA Level 2 or 6th Form Certificate (13) University Entrance (14) NCEA Level 3 or Bursary or Scholarship (15) Overseas qualification (includes International Baccalaureate & Cambridge Exams) (09) Other (98) Not Known (99) Please specify* Will this be the first time you have ever enrolled in a University, Institute of Technology Polytechnic, Institute of Technology College of Education, Industry Training Organisation, Government Training Establishment, Private Training Establishment or Wānanga either in New Zealand or overseas since leaving school?* No Yes Do not include enrolments in community classes.Please enter the name of the organisation you studied at and the year of your first enrolment*What year do you expect to complete the academic requirements of your course/s in order to graduate with your qualification?* Prior AchievementPlease list all of the tertiary qualifications you hold, the month and year you completed each and the tertiary education organisation that it was completed at. Alternatively attach your academic transcript from the tertiary education organisation and/or a copy of your NZQA record of achievementD. DocumentationTo qualify as a domestic student, and so be entitled to the Government tuition subsidy, you must be: a citizen of New Zealand (including students from the Cook Islands, Tokelau, or Niue who have New Zealand citizenship) or a permanent resident of New Zealand or a citizen or permanent resident of Australia residing in New Zealand or a citizen of New Zealand (including students from the Cook Islands, Tokelau, or Niue who have New Zealand citizenship). If you are studying overseas full-time and face-to-face at a campus or delivery site of a New Zealand tertiary education organisation (TEO), you may also qualify as a domestic student if you are a permanent resident of New Zealand or a citizen or permanent resident of Australia and you are studying in an approved country and the overseas study is level 7 or above on the New Zealand Qualification Framework. The 29 approved countries are in the Asia, Latin America and Middle East regions. A full list is available on the Education New Zealand website. You must provide evidence of citizenship or permanent residency. To do so you must produce one of the following: Birth certificate with place of birth stated as New Zealand, Cook Islands, Tokelau, or Niue. New Zealand passport. A certificate of identity. A statement of Whakapapa, including date of birth, countersigned by a kaumatua. A New Zealand certificate of citizenship. Overseas passport with residency stamp. Please provide a certified copy by emailing email@example.com. Certified copy means a photocopy, photograph or scanned copy of your original document, signed as being a true and accurate copy by a Justice of the Peace (JP), Barrister or Solicitor, Notary Public, Court Register or Deputy Registrar, Member of Parliament, Land Transport New Zealand, Public trust, or local authority employee designated for this purpose. When a learner is in a remote community and unable to access a person listed in the Oaths and Declarations Act, a member of the New Zealand Police, school principal, minister of religion, or general practitioner is acceptable. International students must bring their passport with them when they enrol. Please note that your name, date of birth and residency as entered on this enrolment form will be included in the National Student Index, and will be used in an Authorised Information Matching programmes with official governement information such as the New Zealand Birth Register, to verify the information provided. On occasion, more than one National Student Number is created for an individual or data entry errors are made. The Ministry regularly monitors the quality of the National Student Index and, when duplicates or errors are discovered, it works with providers and government agencies to merge duplicates and correct errors. This may require the documentation you provide at enrolment being shared between agencies authorised to access the National Student Index to make these corrections. For further information please see: http://nsi.education.govt.nz/home.aspxF. CONTACT DETAILSHome Address* Street Address Address Line 2 City ZIP / Postal Code Home PhoneMobile Phone*Email* Postal and study addresses My postal address is different I will be living at another address while studying Postal Address* Street Address Address Line 2 City ZIP / Postal Code Address while Studying* Street Address Address Line 2 City ZIP / Postal Code Study address phoneNext of Kin* First Last Next of Kin mobile phone*DECLARATIONPrivacy School of Business Ltd collects and stores information from this form to: manage the business of School of Business Ltd(including internal reporting, administrative processes and selection of scholarship and prize winners) comply with the requirements of the Education Act 1989 and other legislation relating to maintenance of records supply information to government agencies and other organisations as set out below. In signing this enrolment form you authorise such disclosure on the understanding that School of Business Ltdwill observe the conditions governing the release of information, as set out in the Privacy Act 1993, the Education Act 1989 and other relevant legislation. You may see any information held about you and amend any errors in that information. To do so, contact the Enrolments Officer. NB: The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires School of Business Ltd 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/privacy-act Supply of information to government agencies and other organisations School of Business Ltd supplies data collected on this form to government agencies, including: the Ministry of Education the Education New Zealand the New Zealand Qualifications Authority the Tertiary Education Commission the Ministry of Social Development (in relation to student loans and allowances) and Inland Revenue (student loans) Immigration New Zealand and the Ministry of Business, Innovation and Employment (for those who are not New Zealand citizens or permanent residents) agencies which support particular students through scholarships, payment of fees or other awards (if you are a recipient of one of these awards). Those agencies use the data collected from tertiary education organisations to: administer the tertiary education system, including allocating funding develop policy advice for government conduct statistical analysis and research. 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. When required by law, School of Business Ltd releases information to government agencies such as the New Zealand Police, Department of Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC). Information collected on this form may be supplied to other educational organisations for the purpose of verifying academic records. Fees – In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery. <Name of TEO>’s policy on withdrawal and refund of fees may be obtained from the Enrolments Officer. Rules – In signing this enrolment form you undertake to comply with the published rules and policies of <School of Business Ltd> with regard to attendance, academic integrity and progress, conduct and use of information systems. 2This includes legislation governing the maintenance of official records and for accountability for public funding.DeclarationI declare that to the best of my knowledge all the information supplied on, and with, this enrolment 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 Disclaimer: The School of Business Ltd reserves the right to cancel programmes / courses where enrolment numbers are insufficient to make delivery financially viable. In that event, the School of Business accepts no liability for personal expenses incurred by potential students. Any fees paid in this situation will be refunded in full.