Course Enrolment Form

Enrolment Form

Development House, 280 Trafalgar Street, Nelson 7010, New Zealand. Email: admin@aromaticmedicineinstitute.com Phone: 03 545 6218
INSTRUCTIONS:

The purpose of this enrolment form is to obtain from you the information we need to enrol you into a course at our organisation. We also need to collect information from you which is required by government agencies for statistical and registration reasons. Please fill the form properly by:

1. Completing all sections of the form.

2. Typing in your answers clearly, or by ticking the box that applies.

3. Signing the form.

4. Attaching to the form additional documentation that is required.
Course details
Please write the name of the course you wish to enroll into for 2023*
Include the course start date, found on the website
Have you studied with us before*
Do you intend to study full-time or part-time*
Personal details
Name*

TitleFirst NameMiddle NameLast Name
Preferred Name
Previous Name(s) known by
If you have previously enrolled at this organisation under another name, what was that name?
Date of Birth*

MonthDayYear
Date
Gender*
If you know your NSN (National Student Number), please write it here
Driver License Number
Please upload a scan of your current driver license

ID purposes
Cancelof
Contact details
Email*
Alternative email
Phone number*
Include Country calling code for cell phone, NZ is +64
Phone home
Phone work
Website address
Term/Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is your Postal address the same as your Term/Street address*

YesNo
Add Postal address if different from Term/Street address
Is your permanent address the same as your Term/Street address*

YesNo
Add Permanent address if different from Term/Street address

International
Passport number
Please upload scan of your current Passport

ID purposes
Cancelof
Overseas Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Next of Kin
Relationship*
Name*

First NameLast Name
Next of Kin Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Nationality*
Phone number*
Email
example@example.com
Privacy – Aromatic Medicine Institute collects and stores information from this form to:

manage the business of Aromatic Medicine Institute (including internal reporting, administrative processes and selection of scholarship and prize winners)
comply with the requirements of the Education and Training Act 2020 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 the disclosure of your personal information on the understanding that Aromatic Medicine Institute will comply with the legal requirements in relation to the use and disclosure of personal information, as set out in the Privacy Act 2020), the Education and Training Act 2020 and other relevant legislation. You are entitled to see any information that Aromatic Medicine Institute holds about you and request to correct 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 individuals. The Privacy Act requires Aromatic Medicine Institute to collect, hold, handle, use and disclose personal information in accordance with the twelve information privacy principles in the Act. http://legislation.govt.nz/act/public/1993/0028/latest/DLM296639.html?src=qs. From 1 December 2020, the Privacy Act 1993 will be replaced by the Privacy Act 2020, which contains the same privacy principles and governs the collection, use, storage and disclosure of personal information.

Supply of information to government agencies and other organisations

Aromatic Medicine Institute supplies data collected on this form to government agencies, including:

the Ministry of Education
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 (for those who are not New Zealand citizens or permanent residents) and the Ministry of Business, Innovation and Employment
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 Aromatic Medicine Institute to:

administer the tertiary education system, including allocating funding and the administration of the Fees-Free and Fees-Free Trades Training initiatives
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 2020).

When required by law, Aromatic Medicine Institute 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. Aromatic Medicine Institute’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 Aromatic Medicine Institute with regard to attendance, academic integrity and progress, conduct and use of information systems.

This includes legislation governing the maintenance of official records and for accountability for public funding.
Declaration – I 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:

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Enrolment Form

Course details

Personal details

Contact details

Demographics

Employment Status

Schooling

Nationality

Disability

International

Next of Kin