2025 Drive My Life- Central Otago REAP
Please fill in and submit this form as the first step to enrolment to this programme.
Name
*
First Name
Last Name
Please enter any other names you have been known by for example: maiden name
Course Location:
*
Alexandra
Cromwell
Māniatoto
Wānaka
Hāwea
Licence required
*
Learners
Restricted
Full
Date of Birth
*
/
Day
/
Month
Year
Date
Your Ethnicity
*
Māori
NZ European
Australian
Asian
Pasifika
Middle Eastern/ Latin American/African
Other
Your Gender
*
Female
Male
Other
Your Address
*
Your Phone Number
*
eg 021 1234567
Your Email
*
example@example.com
Alternate contact person if we can't get hold of you.
*
Name, phone number and email address
10 NSN Number(if known)
National Student Number
Your Qualifications
*
No formal qualifications
NCEA Level 2/3, 6th Form Certificate or equivalent
Tertiary Qualification
Other
Are you a New Zealand Citizen?
*
Yes
No
Are you a New Zealand Resident?
*
Yes
No
Are you a Migrant or Refugee to NZ?
*
Yes
No
If you answered Yes to being a migrant, have you prepaid for English Language Tuition (PELT)
Yes
No
English is
*
Not my first language
My first language
Please attach a photo of your current driver's licence if you are applying for your restricted or full licence.
Upload image here
Drag and drop files here
Choose a file
Cancel
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To be eligible for this programme you need to meet 1 or more of the following criteria. Please indicate which apply to you.
Lack of financial means
Lack of a suitable vehicle
Lack of a suitable role model or instructor
Please let us know who has referred you to this course.
*
Name
Agency
Do you need support or assistance due to a disability? Please explain
We can support learners with reading and writing, Is this something that would benefit you?
*
Yes
No
Thank you for completing this enrolment form.
If you have any questions or concerns please email paddy@coreap.org.nz or call 021 941685
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