Micro-credential Enrolment Form

TE KUPENGA - CATHOLIC THEOLOGICAL COLLEGE

Edumis Provider Code 8717 registered as Good Shepherd College - Te Hepara Pai Micro-credential Enrolment Form
Auckland +64 9 361 1053

Wellington +64 4 819 8380 www.ctc.ac.nz

All fields marked with a red asterisk* are compulsory
Family Name*
Given Names*
Preferred First Name
Previous name(s) known by
Preferred Title (Please specify)
Date of Birth*

DayMonthYear
Date
National Student Number (if known)
Gender

FemaleMale
Permanent Address

Street Address

Suburb

CityState / Province

Postal / Zip Code
*You must provide at least 1 phone number
Home phone: (h)

Area CodePhone Number
Work phone: (w)

Area CodePhone Number
Mobile

Area CodePhone Number
Email*
example@example.com
Please note that you must notify the College of any change in your contact details.

If you ticked "Other" please write your Postal Address:
Postal Address:

Same as Permanent AddressOther
Postal Address

Street Address

Suburb

CityState / Province

Postal / Zip Code
Invoice Address If someone else is paying your fees
Who is paying your fees? (Name and Address)*
Emergency Contact/Next of Kin *Required
Name of Next of Kin
Phone

Area CodePhone Number
Mobile

Area CodePhone Number
Email
example@example.com
Relationship to you
Academic Information *Required

Secondary Level Education: What was the name of the last secondary school you attended? (State "overseas" if applicable)
School*
Region
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 and Credentials Framework. Your NZQA Record of Learning shows you the standards, credits and qualifications you have acheived.*
** University Entrance attained from 2014 onwards is higher than NCEA Level 3 as Level 3 is one of the requirements that must be met to attain UE.

Tertiary Level Education: Will this be your first year enrolled at a University, Te Pukenga (or subsidiaries - Institutes of Technology or Polytechnic), College of Education, Industry Training Organisation, Government Training Establishment, Private Training Establishment, or Wänanga either in New Zealand or overseas since leaving school? Do not include enrolments in community classes.
Will this be the first Year?:

YesNo
Year of first tertiary enrolment*
If you answered "No", please enter the year of your first enrolment.
If you have completed one or more tertiary qualification enter the name of the highest level qualification.
Name
Level
Institution
Main Activity/Ministry*Required
What is your MAIN activity or occupation in New Zealand?.*
(e.g. Wage or Salary Worker, University Student)
What is your MAIN Volunteer / Ministry involvement in New Zealand?.
English Proficiency
Is English your first language?:

YesNo
If No, what is your first language?
Citizenship and Residency *Required
Are you a New Zealand Citizen?:

Yes
Are you an Australian Citizen?:

Yes
Are you a New Zealand Resident?:

Yes
Are you an Australian Pernament Resident?:

Yes
Country of Citizenship
You MUST provide evidence of citizenship or residency to qualify as a domestic student. This means you must provide one of the following:

Birth certificate with place of birth stated as New Zealand, Cook Islands, Tokelau or Niue

New Zealand passport

Australian passport

Statement of Whakapapa, including date of birth, countersigned by a kaumatua.

NZ Certificate of citizenship or letter of confirmation

Overseas passport with residency stamp or letter from Immigration NZ confirming resident visa details.

IMPORTANT - if your name does not match that on the proof of citizenship/residency you must supply further evidence of your name change.
During your enrolment in this qualification are you resident?
In New Zealand

Yes
Please tick the ethnic group you belong to. You may tick up to three boxes which apply to you. *
Type a question

NZ EuropeanAustralianMāoriFilipinoSamoanVietnameseCook Islands MāoriChineseTonganIndianNiueanSri LankanTokelauanJapaneseFijianKoreanOther Pacific Peoples*CambodianBritish and IrishOther Southeast Asian*DutchOther AsianGreekMiddle EasternPolishAfricanSouth SlavLatin AmericanItalianOther EthnicityGermanNot StatedOther European*
"Other Pacific Peoples", "Other European", "Other Southeast Asian", "Other Asian" or "Other Ethnicity"
If you identified as Mãori above, what is the name of your Iwi and Rohe (iwi home area)? You may enter up to 3 iwi. If you do not know your iwi, please enter "Don't Know".
Iwi
Rohe
Iwi
Rohe
Iwi
Rohe
Disability - Do you describe yourself as disabled, Deaf, neurodiverse, tangata whaikaha Māori, or living with along-term physical or mental health condition? The information you provide is collected for statistical purposes and to help us understand our learners.*

YesNo
Are there supports that would help you while learning at this tertiary institution?*

Access to assistive technology (eg, for reading,writing, communication)Accessible format resources for course contentMobility and transport (eg, movement aroundcampus, mobility carparks, personal emergency evacuation plan)New Zealand Sign Language InterpreterSupport with reading, writing, and communicatingin learning sessions, exams, and assessmentsOther learning or disability supportNo – I do not need support at this time
Management of Church Organisations (Micro-credential)
Please indicate which programme/date you are seeking admission into
Students - check you have included:

Certified copy of Birth Certificate, Passport or Certificate of CitizenshipEvidence of residency (if required)Evidence of name change if your current name does not match that of your passport or birth certificateEvidence of equivalent work experience and learning in a relevant area (if required)
Please send certified copies of original documents. All documents must be certified by a person authorised to certify or a CTC college staff member.
Please upload your supporting documents

Cancelof
Please let us know how you got to know about CTC?
Declaration:
The Privacy Act 2020 has the stated aim of protecting and promoting the privacy of individuals.  It governs the collection, use, storage and disclosure of personal information. CTC handles personal information in accordance with the 13 information privacy principles in the Act.
CTC collects and stores personal information from this form to:
• comply with the requirements of the Education and Training Act 2020 Education and Training Act 2020 and other legislation relating to maintenance of records
• manage its business, including internal reporting, administrative processes and selection of scholarship and award/prize winners; and
• supply information to government agencies and other organisations, as set out below.
CTC will comply with all legal requirements in relation to the use and disclosure of personal information, as set out in the Privacy Act 2020.  You are entitled to see any information that CTC holds about you and request that any errors in the information be corrected. To do so, contact the Registrar.
Disclosure of personal information to government agencies
CTC may supply personal information collected on this form to the following government agencies:
• Tertiary Education Commission
• Ministry of Education
• New Zealand Qualifications Authority
• Ministry of Social Development
• Inland Revenue
• Ministry of Business, Innovation and Employment, including Immigration New Zealand; and
• when required by law, New Zealand Police, Department of Justice and the Accident Compensation Corporation.
The government agencies listed above may use the personal information supplied to them to:
• administer the tertiary education system, including allocating funding and the administration of the Fees Free schemes
• develop policy advice for government
• conduct statistical analysis and research
• update the New Zealand Record of Achievement
• include in the National Student Index or use in an authorised information matching programme with the New Zealand Birth Register
• fulfil their statutory responsibilities
• supply it to Statistics New Zealand to be integrated in Statistics New Zealand's Integrated Data Infrastructure.
Disclosure of personal information to other agencies and organisations
CTC may also supply personal information as applicable to:
• other educational organisations for the purpose of verifying academic records
• Education New Zealand for the purposes of supporting international students
• scholarship providers for the purposes of administering scholarships
• debt collection agencies for the purposes of recovering unpaid fees

Storage of personal information
Data collected from tertiary education organisations is now stored in the Cloud. Student enrolment and course and qualification completion data is stored in a Microsoft datastore based in Sydney, Australia.

Consent

In addition, CTC is asking students for their consent to release names and academic information to Catholic diocesan offices for the purposes of using the data to administer records for the Catholic schools Certification and to conduct research/analysis required for planning PD, resources and needs of schools and parishes.

Consent is also requested to survey relevant employers to determine whether our graduate outcomes are fit for purpose, and to take and use images of students for educational and promotional purposes.

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. CTC's policy on withdrawal and refund of fees is included in the Disclosure of Information to Students and is part of the enrolment information.

Rules – In signing this enrolment form you undertake to comply with the published rules and policies of CTC, Student Policies, with regard to attendance, academic integrity and progress, conduct and use of information systems.

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.

I acknowledge that I have received and read the information entitled Disclosure of Information to Students 2026 as required by section 354(a-c) of the Education and Training Act 2020 prior to my enrolment at CTC.
Signature*

Clear
Date

DayMonthYear
Date
PLEASE SIGN AND DATE YOUR ENROLMENT FORM ON THE LINE ABOVE
*Te Kupenga - Catholic Theological College (CTC), registered as Good Shepherd College - Te Hepara Pai
OFFICE USE ONLY

Signature on behalf of CTC _________________________Name __________________________________ Date ____/____/____
Should be Empty:

TE KUPENGA - CATHOLIC THEOLOGICAL COLLEGE

PLEASE SIGN AND DATE YOUR ENROLMENT FORM ON THE LINE ABOVE

OFFICE USE ONLY