Community Education Enrolment Form

Community Education Enrolment Form

For more details about this course - Phone 07 378 8109 or Email: ako@reapcentralplateau.nz
Programme Name
e.g. Te Reo for Beginners Turangi
Programme Location
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Address

State / Province

Postal / Zip Code
E-mail
example@example.com
Birth Date

DayMonthYear
Gender
Education
Ethnicity
Eligibility
Proof of residency or citizenship required if not born in New Zealand (see below)
Identification required - REAP require your National Student Number (NSN) to complete your enrolment, please add below or leave blank and we will find it for you.
National Student Number
NOTE: If you are not born in New Zealand you are required to provide evidence of residency - please upload

Cancelof
Permission - I consent to any photos taken during this programme to be used on public forums such as Facebook, Newspaper, e-panui or the REAP Annual Report
Declaration:

Privacy - REAP Central Plateau collects and stores information from this form to comply with the requirements of the Tertiary Education Commission. In signing this enrolment form you authorise such disclosure on the understanding that the organisation will observe the general conditions governing the Declaration.

I declare that to the best of my knowledge all the information supplied on, and with, this enrolment form is true and complete, and I consent to the disclosure of personal information as described above.
Signature
Date

DayMonthYear
Should be Empty: