Dear Student

POSTGRADUATE SPECIALIST TEACHING QUALIFICATIONSPostgraduate Specialist SELECTED ENTRY APPLICATION FORM teaching qualifications

Thank you for expressing an interest in the programmes offeredselected by the College entry off Education, Application Massey form Universiity. We are sure that you will enjoy stuudying a Postgraduate Specialist Teaching programme with us.

DearPlease Studentfind included the following information: » Selected Entry Application: Thank youto befor compl expressingeted if youan interestdecide to in sub themmit programme an application offered for sel byection the Institute of Education, Massey University. We are sure that you will enjoy studying a Postgraduate Specialist Teaching programme with us.The processing of applications for the 2012 academic year has started. Completed College of Education selected entry applications must reach the University before the 30th November 2011. It is Pleaseimporta findnt to includednote that theearly following submission information: will sppeed up the processing of your appliccation for a semester one start. {{Selected Entry Application: to be completed if you decide to submit an application for selection For further information on the Postgraduate Diploma in Specialist Teaching prograamme visit Thehttp://ww processingw.massey.ac.nz/ of applicationsmassey/learning /proforg ramme-cthe 2013ourse-paper/pro academicg ramme.cfm?styear has started.udy_year=2012 Completed&prog_id=9348 Institute4&maj or_code.of Education selectedFor other entryCollege applications of Education must programmes reach the visit University http://study.massey before 5 December.ac.nz. 2012. It is important to note that early submission will speed up the processing of your application for a Semester One start. If you have any queries with regard to your application or you require any further aassistance please Fordon't further hesitate information to contact onus onthe 0 Postgraduate800 MASSEY (0800 Diploma 627 in 739) Specialist or +64 6 Teaching 350 5701 programme,if calling from visit: http://www.massey.ac.nz/programme/?id=93484overseas or e-mail us at [email protected].

We look forward to receiving your application. We look forward to receiving your application.

YoursYours sincerely,siincerely

ToniToni Snowball-Kui Snowball-Kui Academic Services Manager, Student Management (Education) Academic Services Manager, Student Management (Education) selected entry Postgraduate Specialist teaching qualifications

APPLICATIONS CLOSE 5 DECEMBER Completing the form The University-Student Contract The information you give on this entry form is used by the selection The University and the Student form a contractual relationship when the committee to select candidates for entry into the Postgraduate University enrols the Student as a member of the University community. Certificate or Postgraduate Diploma in Specialist Teaching. What follows are the terms of that Contract which the University and the Student accept are to govern their relationship, along with statute, and Need help? with the regulations and rules of the University. If you need help answering any questions, simply call our Helpline: phone 0800 MASSEY (0800 62 77 39). The University will: 1 Use best endeavours to provide the Student with tuition and Verifying your documents supervision of a professional standard in the course(s) in which the Please attach verified copies of your proof of identity and the relevant Student is enrolled. qualifications requested in this form. 2 Act reasonably and fairly in exercising its powers under the regula- What is a verified copy? tory framework and this Contract. A verified copy is a copy of an original document that has been signed and 3 Give reasonable notice of any changes in the course(s) required dated (preferably with an official stamp) for authenticity by a person authorised because of changes in funding, staffing or other reasonable cause. in the Oaths and Declarations Act 1957 as able to take declarations. This The Student will: person could be a: 4 Use best endeavours to fulfil the requirements prescribed by the • Justice of the Peace University for the course(s). • Barrister or solicitor of the High Court 5 Observe the regulations and rules of the University and accept the • Notary Public jurisdiction of the University in all matters connected with academic • Court Registrar or Deputy Registrar • Member of Parliament progress and with discipline. • Land Transport Safety Authority, Public Trust, government department 6 Pay the fees prescribed by the University for the course(s). (including Internal Affairs and Inland Revenue) or local authority employee The University and the Student also agree: designated for the purpose of taking oaths and declarations. 7 The Contract is formed when a Confirmation of Enrolment is issued When a student is in a remote community and is unable to access a person for the programme(s). from the above list, a school principal, minister of religion or general 8 The Contract will continue for the period for which the Student is practitioner is acceptable. enrolled by the University and will then end. However, clause 12 will A verified copy of a whakapapa statement is acceptable only when a student continue to apply after the Contract ends. cannot obtain a birth certificate. Both the student and a kaumatua must sign 9 The University and the Student may enter into further contracts, in the whakapapa as evidence of identity and citizenship. subsequent periods, by repeating the process in clause 7. The signatory must identify their official designation and location on the front 10 The relevant Admission Form, Enrolment Form, Confirmation of of each page of the copy (preferably with an official stamp), sign and date the Enrolment and material published in the Calendar also form part copy and write the following words (or words to the same effect): “This is a true copy of an original document that I have sighted”. of this Contract, but nothing else shall be incorporated into the contractual relationship between the Student and the University. Failure to provide correctly verified documentation may delay or lead to rejection of your application. 11 Liability for failure to perform this Contract is excluded where that failure has been caused by circumstances beyond the control of the The document with the verification must be received by Massey University and University or the Student. not a copy or fax of the verified copy. 12 Any dispute arising out of or in connection with this Contract, or The University does not return verified copies to you. Please do not send otherwise relating to the performance by the University or its staff original identity documents. If you do send originals, Massey University does of their responsibilities to the Student, shall be resolved through the not guarantee secure return of these documents to you. Grievance Procedures prescribed by the University (see Calendar As an alternative to sending in verified copies of your documents you can show or http://calendar.massey.ac.nz/) which shall be the exclusive the originals to a Massey University staff member who will take a copy of your procedures for resolution of such a dispute. original documents and sign and date the copy to show that the documents have been sighted. Eligibility criteria To be eligible to apply for the Postgraduate Certificate or Postgraduate Ready to send? Diploma in Specialist Teaching you must: When you’ve finished filling in this form, please send it along with any (a) hold a relevant professional qualification; attachments asked for in the addressed envelope to: (b) have either Enrolments i) qualified for any degree of a New Zealand university, or Massey University equivalent; or Private Bag 11222 ii) provided evidence of sufficient practical/professional experience Manawatū Box Lobby of an acceptable standard in an area relevant to the qualification; Palmerston North 4442 New Zealand (c) have satisfied the Academic Board that they have sufficient background of professional experience to be likely to benefit from We will send an acknowledgement to you advising that we have the course; received your application. (d) been granted admission to postgraduate study as entitled to enrol for the Postgraduate Diploma in Specialist Teaching. Note: The Selection Committee reserves the right to consult with other professionals in your field who may be knowledgeable of your work. You may also be asked to provide the names of additional referees.

2 SELECTED ENTRY FORM – POSTGRAD SPECIALIST TEACHING

If you need help with any question, phone 0800 MASSEY (0800 62 77 39).

Personal details Language Surname or family name Is English or Māori your first language? Yes No If ‘No’, what is your first spoken language?

First or given names Citizenship Date of birth Are you a New Zealand citizen or permanent resident? Yes No Day Month Year If you are a Permanent Resident, how long have you lived in New Zealand?

Massey ID number (if known)

Disabilities Contact details Do you have any disability/health conditions that may affect your study Yes No Address Will you require learning support? Yes No Please specify

E-mail

Phone (daytime) ( )

Phone (evening) ( )

Cellphone ( ) If yes, please see also the Registration Form for Disability Services at the back of this forms booklet. Qualification Please tick appropriate box 2256 Postgraduate Certificate in Specialist Teaching (unendorsed)

2610 Postgraduate Diploma in Specialist Teaching

Please tick one endorsement for the Postgraduate Diploma in Specialist Teaching 2472 Gifted and Talented

2853 Autism Spectrum Disorder

2854 Blind and Vision Impairment

2855 Learning and Behaviour

Complex Educational Needs (Subject to CUAP approval)

Study Award Please indicate if: • you have applied for a Study Award. Yes No • you have been advised by the Ministry of Education you are receiving a Study Award. Yes No • You are employed as a Resource Teacher of Learning Behaviour (RTLB) Yes No

3 SELECTED ENTRY FORM – POSTGRAD SPECIALIST TEACHING

Academic history Undergraduate qualifications Name of institution Degree/Certificate Subject/Major Year completed

Undergraduate papers Name of university Paper number Paper name Year Grade

Postgraduate qualifications Name of institute/organisation Degree/certificate or other qualification Main subject/s Year attended you received or were studying studied completed

Postgraduate education papers Name of university Paper number Paper name Year Grade

4 SELECTED ENTRY FORM – POSTGRAD SPECIALIST TEACHING

Postgraduate education papers (continued) Name of university Paper number Paper name Year Grade

Experience in educational settings (most recent first) Employer Position held Professional responsibilities Dates employed

Any further professional training qualifications and experience

List professional publications and research reports (append on a separate sheet if necessary)

List professional associations/organisations in which you are a member

Current teacher registration number

5 SELECTED ENTRY FORM – POSTGRAD SPECIALIST TEACHING

Attach to the application Disclosure • Copy of your CV Have you any convictions which are able to be • Verified copies of academic transcripts to support your application disclosed under the Criminal Records (if you graduated from Massey University we have access to (Clean Slate) Act 2004 Yes No your academic record so there is no need to supply an academic transcript). Have you any charges pending? Yes No • A verified copy of your current teacher registration card. If you have not attached a verified copy of your current teacher registration card to your application, the Institute of Education requires students selected into a Specialist Teaching qualification to be vetted by the Licensing & Vetting Service Centre. Please complete the Consent to Disclosure of Information form on Page 7 and include with your application form. Declaration I declare all information provided on this application to be true and correct Signature

Date:

Before posting see checklist on page 18.

6 CONSENT TO DISCLOSURE OF INFORMATION POSTGRAD SPECIALIST TEACHING

Licensing & Vetting Service Centre Office of the Commissioner PO Box 3017 Wellington 6140

I, Surname

Forenames

Maiden, or any other names used

Sex Male Female

Date of birth

Place of birth

Nationality

Residential address

Suburb

City

NZ Driver Licence number*** (see below)

hereby consent to the disclosure by the New Zealand Police of any information relating to any interaction I have had with Police in any context, to the Institute of Education, Massey University. I understand that any record of criminal convictions I might have will automatically be concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records (Clean Slate) Act 2004. Signed

Date

***Note: Please attach a verified copy of your Driver Licence and/or Passport. If neither is held, then the verified copy of your Birth Certificate supplied with your application will suffice.

Agency Code: M70119

7 8 ENROLMENT FORM – POSTGRAD SPECIALIST TEACHING

If you are a returning student please complete the Returning Student form instead (pages 15-17). Please fill in this form if you are enrolling for the first time at Massey University. If you need help with any question, phone 0800 MASSEY (0800 62 77 39).

Surname or family name 1. Massey University Student ID number Verified If you have already been given a Massey University Student ID number, 1 please write it below (if known). Not verified First or given names 2 Not supplied 3 2. Name Please write your full legal name and attach a verified copy of your 5. Gender birth certificate, whakapapa or your passport. Tick box Male 1 Female 2 Surname or family name 6. Date of birth Day Month Year First or given names

Attach a verified copy of birth certificate or whakapapa (that includes 3. Preferred first name your date of birth) or valid passport. If you prefer to be known by a different first name to the one shown in Office use only Verified Not verified Not supplied Question 2, please write it below. 1 2 3

7. Main contact address 4. Changed your name? (normally your residential address while you are studying, otherwise a If your current name is different from the name on your birth certificate, current reliable contact address). passport, or citizenship certificate, or the name showing on any You must advise Massey University of any address change while you qualifications you have gained, you must also provide an original or are studying. verified copy of one or more of the following as formal evidence of each Street address change: • Marriage or civil union certificate • Certificate of dissolution of marriage or civil union • Deed poll Suburb • Statutory declaration issued by an appropriate authority such as a Justice of the Peace, School Principal. Any document concerning a name change must include both the old Town/City name and the new name. Surname or family name Office use only Verified Postcode Country 1 Not verified First or given names 2 Not supplied 8. Contact details 3 (E-mail is Massey University’s primary method of contact).

Surname or family name Phone (daytime) ( ) Verified 1 Not verified Phone (evening) ( ) First or given names 2 Not supplied Cellphone ( ) 3

Fax ( ) Surname or family name Verified At the time your Student ID is created you are also given a Massey 1 e-mail address; you will be notified of your assigned address once Not verified your enrolment is processed. If you wish to have your Massey e-mail First or given names 2 forwarded to an alternative e-mail address, please indicate your Not supplied preferred e-mail address below 3 E-mail

9 ENROLMENT FORM – POSTGRAD SPECIALIST TEACHING

9. Previous contact address Massey University is committed to providing equal Main address where you have lived in the last 12 months (if different educational opportunities for all students. The information from Question 7). you supply in this section is used for statistical purposes Same as Question 7 (please tick) only. We are required to collect the following personal Street address details on behalf of the Ministry of Education. 12. Citizenship The first time any student applies to enrol at Massey University they are Suburb required to show proof of citizenship and eligibility to study. Please tick one box from A, B, C or D below to indicate your citizenship status. Then in the right hand column please tick to show which form Town/City of documentation you are supplying with this application form. It is essential to provide a verified copy of documentation. If you are a citizen of a country other than New Zealand and have Postcode a student/work/visitor permit, or, you are an Australian citizen or permanent resident intending to study from Australia, you must complete the separate International Application form, found on our Country website at http://international.massey.ac.nz A 200 New Zealand Citizen New Zealand birth certificate 10. Alternative contact address New Zealand Passport An alternative address that Massey can use to contact you (eg home, next of kin, employer) Certificate of New Zealand Citizenship or letter of Street address confirmation

A statement of whakapapa stating your full name, date of birth, and counter signed by a kaumataua Suburb or a notable member of the Māori community.

Birth Certificate with place of birth stated as Cook Islands, Niue or Tokelau Town/City B New Zealand Permanent Residency Passport with New Zealand Permanent Residency Postcode stamp My country of citizenship

Country

C 215 Australian Citizen or Permanent Resident 11. Emergency contact Australian birth certificate Please identify the person you would like us to contact in an Australian Passport emergency. Name Passport with Australian permanent residency stamp

Note: to enrol as a domestic student you must be What is this person’s relationship to you? (eg parent, husband, brother, resident in New Zealand while studying. sister) D Refugee status A document from the New Zealand Immigration Service as evidence of your application for Phone (daytime) ( ) refugee status. (English courses only)

Phone (evening) ( )

Office use only Verified Not verified Not supplied Cellphone ( ) CIT 1 2 3

E-mail NZPR 1 2 3

10 ENROLMENT FORM – POSTGRAD SPECIALIST TEACHING

13. Ethnicity 16. IRD number What ethnic groups do you belong to? (You may tick up to three boxes). If you intend studying and applying for a Student Loan, please write your IRD number below. 01 NZ European/Pakeha

20 NZ Māori

If you tick this box, please complete the Iwi/Tribal Affiliation Interest Free Student Loans and other Interest Write-Offs (question 14) below. On 1 April 2006, legislation was introduced to make student loans interest free for borrowers living in New Zealand. 31 Samoan Completing your IRD number is voluntary. This is requested so the 34 Niuean Ministry of Education can share information with the IRD regarding student enrolments. If you choose to provide your IRD number on the 32 Cook Island Māori enrolment form this will be included with your enrolment details and will be reported to the Ministry of Education. 36 Fijian For more information on interest free student loans, visit 33 Tongan www.ird.govt.nz/studentloans 35 Tokelauan 17. High/Secondary School attended 51 Chinese Please name the high/secondary school you are currently (or were last) enrolled at. 37 Other Pacific Groups Name of School 68 Other South East Asian

52 Indian Town/City 89 Other (please specify)

Country 14. New Zealand Māori – Tribal affiliation Please refer to the list of Iwi codes at the back of this book, and enter Last year of attendance the appropriate four-digit code(s) below. If you identify with more than Office use only one iwi, please list in order of priority. Iwi code First 18. Highest school qualification What is the highest level of achievement you hold from secondary school? Second You may have achieved a number of credits or a National Certificate at a certain level on the National Qualifications Framework. Your NZQA record Third of learning shows how many credits you have. Alternatively your highest achievement may have been an award such as School Certificate or New 15. Prior activity Zealand University Entrance. (Tick only one box) Please tick your main activity as at 1 October. 81 NCEA Level 3 or Bursary or Scholarship

01 Secondary school student 06 NZ University Entrance

02 Not employed or beneficiary (excludes retired) 07 NCEA Level 2 or Sixth Form Certificate

03 Wage or salaried worker 08 NCEA Level 1 or School Certificate

04 Self-employed 40 14 or more credits at any level – no formal qualification 05 University student 30 Overseas qualification (includes International 06 Polytechnic student Baccalaureate and Cambridge exams)

08 Houseperson or retired 09 No formal secondary qualifications

09 Overseas (regardless of what you were doing) 98 Other, please specify: 11 Private training establishment student

12 Wananga student

11 ENROLMENT FORM – POSTGRAD SPECIALIST TEACHING

19. Language of instruction 23. Papers Was English the language used to teach the subjects in which you Location Mode Title Paper number achieved your highest school qualification?

1 Yes If Yes, please go to Question 20

2 No If no, please answer the following questions:

What was the language used?

Have you sat an English language competence test?

1 Yes

2 No

If yes, please provide the following details: Name of test

Score Year taken

Please attach a verified copy of your test results

Office use only Supplied Not supplied 1 2

20. Disabilities Do you live with the effects of a significant injury, long-term illness, or disability?

Yes No 1 2

If you require the support of Massey University’s Disability Services you will need to complete the Disability Services Registration Form at the back of this form. Upon receipt of this form Disability Services will contact you. 21. Programme of study Please tick. 2256 Postgraduate Certificate in Specialist Teaching (unendorsed) 2610 Postgraduate Diploma in Specialist Teaching

22. Endorsements Please indicate one endorsement for the Postgraduate Diploma in Specialist Teaching 2427 Gifted and Talented 2853 Autism Spectrum Disorder 2854 Blind and Low Vision 2855 Learning and Behaviour Complex Educational Needs (Subject to CUAP approval)

12 ENROLMENT FORM – POSTGRAD SPECIALIST TEACHING

24. Admission to Graduate and Postgraduate level programmes Complete this section if you are applying for a graduate or postgraduate programme.

Applicants who have studied at Massey University Please complete the Returning Students form on page 15.

Applicants who have studied at another New Zealand tertiary education institution

25 Please complete the following table to indicate your study at another New Zealand tertiary education institution(s).

Name of tertiary institution Programme of Study From To Completed

Yes No

Yes No

Yes No

Yes No

Attach a verified copy of your academic transcript showing results from each year of study.

Go to page 17 and sign the declaration.

Applicants who have studied at a tertiary education institution overseas

25 Please complete the following table to indicate your study at an overseas tertiary education institution(s).

Name of tertiary institution Programme of Study From To Completed

Yes No

Yes No

Yes No

Yes No

Attach a verified copy of your academic transcript showing results from each year of study.

There is a non-refundable fee for assessment of overseas qualifications unless the qualification has already been assessed by the New Zealand Qualifications Authority (NZQA). Please attach evidence of NZQA assessment or complete the Payment of Fees Remittance Advice on page 19 and include your payment with this form.

Payment enclosed – please complete page 19.

Go to page 17 and sign the declaration.

Other applicants

25 I have not studied at any tertiary education institution. I am applying on the basis of my experience.

Attach a current curriculum vitae.

There is also a non-refundable fee for assessment of prior experience. Please complete the Payment of Fees Remittance Advice on page 19 and include your payment with this form.

Payment enclosed – please complete page 19.

Go to page 17 and sign the declaration.

13 14 RETURNING STUDENT ENROLMENT FORM POSTGRAD SPECIALIST TEACHING

Do not use this form if you are enrolling for the first time at Massey University. Instead, complete the Enrolment Form on pages 9-13 and declaration on page 17.

1. Massey University Student ID number 5. Main contact address If you have already been given a Massey University Student ID number, (Normally your residential address while you are studying, otherwise a please write it below (if known). current reliable contact address). You must advise Massey University of any address change while you are studying. Street address

2. Name Surname or family name Suburb

First or given names Town/City

Postcode Country 3. Date of birth Day Month Year

6. Contact details

Phone (daytime) ( ) 4. Changed your name? If your current name is different from the name on your birth certificate, Phone (evening) ( ) passport, or citizenship certificate, or the name showing on any qualifications you have gained, you must also provide an original or verified copy of one or more of the following as formal evidence of each Cellphone ( ) change: • Marriage or civil union certificate • Certificate of dissolution of marriage or civil union Fax ( ) • Deed poll • Statutory declaration issued by an appropriate authority such as a E-mail Justice of the Peace, School Principal. Any document concerning a name change must include both the old E-mail is Massey’s preferred method of contact. name and the new name.

Surname or family name Office use only 7. Previous contact details Verified Main address where you have lived in the last 12 months (if different 1 from Question 5) . Not verified First or given names 2 Same as Question 5 (please tick) Not supplied 3 Street address

Surname or family name Verified Suburb 1 Not verified First or given names 2 Town/City Not supplied 3

Postcode Country

15 RETURNING STUDENT ENROLMENT FORM – POSTGRAD SPECIALIST TEACHING

8. Alternative contact details 11. IRD number An alternative address that Massey can use to contact you (eg home, If you intend studying and applying for a Student Loan, please write your next of kin, employer) IRD number below. Street address IRD number

Interest Free Student Loans and other Interest Write-Offs Suburb On 1 April 2006, legislation was introduced to make student loans interest free for borrowers living in New Zealand. Completing your IRD number is voluntary. This is requested so the Town/City Ministry of Education can share information with the IRD regarding student enrolments. If you choose to provide your IRD number on the enrolment form this will be included with your enrolment details and will be reported to the Ministry of Education. Postcode Country For more information on interest free student loans, visit www.ird.govt.nz/studentloans

9. Emergency contact 12. Programme of study Please identify the person you would like us to contact in an emergency. Please tick. Name 2256 Postgraduate Certificate in Specialist Teaching (unendorsed) 2610 Postgraduate Diploma in Specialist Teaching What is this person’s relationship to you? (eg parent, husband, brother, sister) 13. Endorsements Phone (daytime) ( ) Please indicate one endorsement for the Postgraduate Diploma in Specialist Teaching Phone (evening) ( ) 2427 Gifted and Talented 2853 Autism Spectrum Disorder Cellphone ( ) 2854 Blind and Low Vision E-mail 2855 Learning and Behaviour Complex Educational Needs (Subject to CUAP 10. Prior activity approval) Please identify the person you would like us to contact in an emergency. Please tick your main activity as at 1 October. 14. Papers Location Mode Title Paper number 01 Secondary school student

02 Not employed or beneficiary (excludes retired)

03 Wage or salaried worker

04 Self-employed Please indicate only the papers that you are doing in the 2013 academic year. 05 University student 15. Disabilities 06 Polytechnic student Do you live with the effects of a significant injury, long-term illness, or disability?

08 Houseperson or retired Yes No 09 Overseas (regardless of what you were doing) 1 2

11 Private training establishment student If you require the support of Massey University’s Disability Services you will need to complete the Disability Services Registration Form at the back of this form. 12 Wananga student Upon receipt of this form Disability Services will contact you.

16 Declaration

1. Declaration (vii) My name, date of birth and residency as entered on this enrolment application will be included in the National Student Index, and will I declare that the information given in this form is true and correct, and no be used in an Authorised Information Matching programme with the information that may have a bearing on my enrolment has been withheld. New Zealand Birth Register. For further information please see http:// I understand and agree that this Enrolment Application will form part of nsi.education.govt.nz/ a contract between me and Massey University. The other terms of that (viii) Security of personal information about me that is held by Massey contract are set out or referred to in the document entitled “Student University is protected by a personal identification number (PIN) Contract” which can be viewed on the Massey University website. The or other unique identifier (“unique identifier”) provided to me by Contract will be formed when I accept the Offer of Place. Even after I Massey University. I confirm that the evidence of identity I have accept any Offer of Place my enrolment contract at Massey University provided to the University belongs to me, I authorise the use of the may be subject to conditions being satisfied or waived by Massey unique identifier for admission and enrolment purposes, I accept University by notice in writing to me. Even after I receive a Confirmation of responsibility for all uses of my unique identifier and I agree not to Enrolment Massey University may still cancel my enrolment as permitted give my unique identifier to other people. by law or as permitted in the University’s agreement with me. I authorise the use of my personal information (including photos) for By submitting this Enrolment application I understand that: purposes related to my studies and for the provision and improvement of (i) I am solely responsible for ensuring that any Offer of Place I accept services for students of the University. is for a programme that I am eligible to study and wish to study, (Ii) I alone decided to study the programme for which I have applied. Signature I am not relying on any advice from Massey University that a programme is suitable for any purpose unless I have that advice in writing from Massey University. (iii) Books, journals and other materials made available to me by Massey University are for my own studies only, and copying or using them for other purposes is an infringement of copyright; Day Month Year (iv) Massey University’s Policy on Intellectual Property will apply (v) I have the right to access the personal information which Massey University holds about me and the right to request the correction of Massey University Student ID number (if known) that information; (vi) Information about me may be held by, used by and disclosed to the following organisations: Massey University and its wholly owned subsidiary companies, other tertiary providers with whom Massey University has entered into joint ventures or other contractual arrangements, Massey University’s Alumni Association, Students’ Associations, Extramural Office use only Signed Not signed Students’ Society and related Trusts, Ministry of Education, Tertiary 1 2 Education Commission, StudyLink, Inland Revenue Department, Dept of Work and Income, Ministry of Foreign Affairs and Trade and Specialist Education Services, Tribal trusts and scholarship providers, other tertiary institutions that I am transferring to or from, New Zealand Teachers Council and other professional accreditation agencies, other agencies where disclosure is permitted or required by law.

17 CHECKLIST

Have you: Payment of fees nnanswered all questions? The payment of your university fees is governed by the University’s fees nnattached a verified copy of your birth certificate or whakapapa or regulations which students are required to observe. You can pay your the inside front cover of your valid passport? fees in a number of different ways. These are explained below. Please select the option that is most convenient for you. attached a verified copy of proof of permanent residence in New nn Bank Zealand (only required if a citizen of another country)? Direct Lodgement / Internet banking – Payments can be made by paying nnattached a verified copy of proof of name change (if applicable)? directly into the University Bank Account. Please contact treasury@ massey.ac.nz for bank details or call 0800 MASSEY. Reference details attached a verified copy of any results you have attained from nn should include your student ID and the reference “fees payment.” tertiary education (polytechnic, wananga, university)? Please ensure that the transcripts show subjects and grades and also attach Cheque certificates showing the qualifications you have gained. Attach your cheque to the remittance advice form and print the student’s name, student’s ID (if known) and address on back of the cheque. All nnattached a verified copy of your current teacher registration card? cheques must be made payable to Massey University and crossed “Not nnattached a curriculum vitae? Transferable”. Please do not post-date cheques. attached payment (if required)? Credit card payments nn Credit card payments can be made via MyMassey, login at www. nncompleted the Request for Student ID Card section and attached a mymassey.com or by completing all the credit card details on the passport-sized photograph? remittance advice. The University accepts Visa/Mastercard/Amex credit nnsigned and dated the declaration section? This is very important, cards. your enrolment cannot proceed without this signature. EFTPOS/cash Pay at the cashier’s desk at any Massey University campus, quoting your full name and Massey University Student ID. Do not send cash by mail. Yes? Great! Please post this form and all attachments in the Return Envelope to: Student Loan Enrolments To apply for a Student Loan please visit http://www.studylink.govt.nz/ Massey University Private Bag 11222 For further information on fees, particularly supplementary charges, Manawatū Box Lobby such as the Student Services Levy, Enrolment fee, etc, please refer to the Palmerston North 4442 Massey website (http://fees.massey.ac.nz)

Are you eligible to study at Massey University?

Admission to graduate and postgraduate qualifications Entrance to graduate and postgraduate study is usually programme and major specific, and may have conditions attached. Applications require at Postgraduate programmes include Honours and Masters degrees as well least 15 working days to process. You should apply well before the start of as Postgraduate Diplomas and Certificates. Note that students applying the semester in which you intend to study. for admission to a doctoral programme should refer to the Graduate Research School web pages at http://grs.massey.ac.nz for admission Verified transcripts from all of your previous tertiary study are essential procedures. if you are applying for graduate or postgraduate programmes unless you completed your previous degree at Massey University. Graduate programmes include Graduate Diplomas and Certificates (with the exception of the Graduate Diploma in Business and the English language requirements Graduate Diploma in Logistics and Supply Chain Management which are undergraduate qualifications). All students studying at Massey University are expected to be able to write grammatically correct English, read English actively and with Recognised entrance qualifications for Graduate and Postgraduate understanding, listen to and discern key points in spoken English and programmes differ by programme and you should refer to the admission speak English freely and clearly. Procedures also exist for those students requirements for your programme of choice on the Study at Massey web who wish to submit written work or examinations in Māori. pages at http://study.massey.ac.nz, or in the relevant enrolment book. Generally, graduate and postgraduate programmes require students to All international students whose first language is not English will be hold one or more of the following: required to provide satisfactory evidence of their English language proficiency in the form of an academic IELTS or TOEFL score. More • a relevant Massey University degree with above average achievement information is available on the International students web pages at http:// as measured by grade point average international.massey.ac.nz. • a relevant degree from another New Zealand tertiary institution with above average achievement as measured by grade point average • a relevant degree from a recognised tertiary institution offshore with above average achievement as measured by grade point average • relevant practical, professional or scholarly experience equivalent to that of a graduate. Note not all graduate and postgraduate qualifications permit entry on this basis.

18 REQUEST FOR A STUDENT ID CARD

Massey University Student ID number (if known) Is this an updated photo for a replacement card?

Yes No

Date of birth New card required for other reasons (please specify): Day Month Year

Note: There is a fee for replacement cards for name change, lost/stolen, or updated Surname or family name (please write your full legal name in capital letters) photo if you have a current card.

First name(s) Remove this strip and attach your Photos must meet all these requirements: passport-sized • Taken within the last six months. photo here • Full front view of face. Head must fill most of the photo. • Must be a plain light coloured background. • No hat or head covering (except for religious reasons). • No sunglasses or dark tinted lenses. • Must be on good quality photo paper (No photocopies accepted). • Scanned photos are unacceptable. Note: processing ID cards commences in January. In most cases you should receive Is this the first photo you have supplied? your ID Card before the commencement of your studies. Yes No Please return to: Enrolments Massey University, Private Bag 11222, Manawatu Box Lobby Palmerston North 4442.

REMITTANCE ADVICE NOTE: Do not complete this section if you are paying fees with a Student Loan. Payment of Selection Assessment fee Massey University Student ID number (if known)

Assessment of Overseas Qualification fee

Date of birth Payment by credit card Please complete the following details: Day Month Year Visa

Mastercard Surname or family name (please write your full legal name in capital letters) Amex Card number First name(s)

Name of cardholder (please print) Mailing address

Expiry date Month Year

Postcode Amount $

Phone (daytime) ( ) Signature

Do you require a receipt? Yes No

Payment by cheque $

19 IWI CODES

Te Tai Tokerau/Tāmaki-makaurau Te Matau-a-Māui/Wairarapa (Hawke’s Bay/ Iwi not named, but waka or Iwi confederation (Northland/Auckland) Region Wairarapa) Region known 0100 Te Tai Tokerau/Tāmaki-makaurau 0700 Te Matau-a-Māui/Wairarapa 2001 Tainui (Northland/Auckland) Region (not further defined) (Hawke’s Bay/Wairarapa) Region not 2002 Te Arawa 0101 Te Aupōuri further defined 2003 Tākitimu 0102 Ngāti Kahu 0701 Rongomaiwahine (Te Māhia) 2004 Aotea 0103 Ngāti Kurī 0702 Ngāti Kahungunu ki Te Wairoa 2005 Mātaatua 0104 Ngāpuhi 0703 Ngāti Kahungunu ki Heretaunga 2006 Mahuru 0105 Ngāpuhi ki Whaingaroa-Ngāti Kahu ki Whaingaroa 0704 Ngāti Kahungunu ki Wairarapa 2007 Māmari 0106 Te Rarawa 0705 Ngāti Kahungunu, region unspecified 2008 Ngātokimatawhaorua 0107 Ngāi Takoto 0706 Rangitāne (Te Matau a Māui/Hawke’s Bay/ 2009 Nukutere 0108 Ngāti Wai Wairarapa) 2010 Tokomaru 0109 Ngāti Whātua 0707 Ngāti Kahungunu ki Whanganui-a-Orotu 2011 Kurahaupō 0110 Te Kawerau 0708 Ngāti Kahungunu ki Tamatea 2012 Muriwhenua 0111 Te Uri-o Hau 0709 Ngāti Kahungunu ki Tamakinui a Rua 2013 Hauraki / Pare Hauraki 0112 Te Roroa 0710 Ngāti Pāhauwera 2014 Tūranganui a Kiwa Hauraki (Coromandel) Region 0711 Ngāti Rākaipaaka 2015 Te Tauihu o Te Waka a Māui Taranaki (Taranaki) Region 2016 Tauranga Moana 0200 Hauraki (Coromandel) Region 2017 Horouta (not further defined) 0800 Taranaki (Taranaki) Region not further 0201 Ngāti Hako defined Iwi named but region unspecified 0202 Ngāti Hei 0801 Te Atiawa (Taranaki) 2101 Te Atiawa, region unspecified 0203 Ngāti Maru (Marutuahu) 0802 Ngāti Maru (Taranaki) 2102 Ngāti Haua, region unspecified 0204 Ngāti Paoa 0803 Ngāti Mutunga (Taranaki) 2103 Ngāti Maru, region unspecified 0205 Patukirikiri 0804 Ngā Rauru 2104 Ngāti Mutunga, region unspecified 0206 Ngāti Porou ki Harataunga ki Mataora 0805 Ngā Ruahine 2105 Rangitāne, region unspecified 0207 Ngāti Pūkenga ki Waiau 0806 Ngāti Ruanui 2106 Ngāti Raukawa, region unspecified 0208 Ngāti Rāhiri Tumutumu 0807 Ngāti Tama (Taranaki) 2107 Ngāti Tama, region unspecified 0209 Ngāi Tai (Hauraki) 0808 Taranaki 2108 Ngāti Toa, region unspecified 0210 Ngāti Tamaterā 0809 Tangāhoe 2109 Waitaha, region unspecified 0211 Ngāti Tara Tokanui 0810 Pakakohi 2110 Ngāti Apa, area unspecified 0212 Ngāti Whanaunga Whanganui/Rangitīkei 2111 Ngāi Tai, area unspecified Waikato/Te Rohe Pōtae (Wanganui/Rangitīkei) Region Hapū affiliated to more than one Iwi (Waikato/King Country) Region 0900 Whanganui/Rangitīkei (Wanganui/ 2200 Hapū affiliated to more than one Iwi 0300 Waikato/Te Rohe Pōtae (Waikato/ Rangitīkei) Region not further defined Other responses King Country) Region (not further defined) 0901 Ngāti Apa (Rangitīkei) 0301 Ngāti Haua (Waikato) 0902 Te Ati Haunui-a-Pāpārangi 4444 Don’t know 0302 Ngāti Maniapoto 0903 Ngāti Haua (Taumarunui) 0303 Ngāti Raukawa (Waikato) 0904 Ngāti Hauiti 0304 Waikato Manawatū/Horowhenua/Te Whanganui-a-Tara Te Arawa/Taupō (Rotorua/Taupō) Region (Manawatū/Horowhenua/Wellington) 0400 Te Arawa/Taupō (Rotorua/Taupō) Region 1000 Manawatū/Horowhenua/Te Whanganui-a- (not further defined) Tara (Manawatū/Horowhenua/Wellington) 0401 Ngāti Pikiao (Te Arawa) Region not further defined 0402 Ngāti Rangiteaorere (Te Arawa) 1001 Te Atiawa (Te Whanganui a Tara/ 0403 Ngāti Rangitihi (Te Arawa) Wellington) 0404 Ngāti Rangiwewehi (Te Arawa) 1002 Muaūpoko 0405 Tapuika (Te Arawa) 1003 Rangitāne (Manawatū) 0406 Tarāwhai (Te Arawa) 1004 Ngāti Raukawa (Horowhenua/Manawatū) 0407 Tūhourangi (Te Arawa) 1005 Ngāti Toarangatira (Te Whanganui a Tara/ 0408 Uenuku-Kōpako (Te Arawa) 0409 Waitaha (Te Arawa) Wellington) 0410 Ngāti Whakaue (Te Arawa) 1006 Te Atiawa ki Whakarongotai 0411 Ngāti Tūwharetoa 1007 Ngāti Tama ki Te Upoko o Te Ika 0412 Ngāti Tahu-Ngāti Whaoa (Te Arawa) (Te Whanganui-a-Tara/Wellington)Te Tauranga Moana/Mātaatua (Bay of Plenty) Waipounamu/Wharekauri Region (South Island/Chatham Islands) Region 0500 Tauranga Moana/Mātaatua 1100 Te Waipounamu/Wharekauri (South Island/ (Bay of Plenty) Region (not further defined) Chatham Islands) Region not further defined 0501 Ngāti Pūkenga 1101 Te Atiawa (Te Waipounamu/South Island) 0502 Ngaiterangi 1102 Ngāti Koata 0503 Ngāti Ranginui 1103 Ngāti Kuia 0504 Ngāti Awa 1104 Kāti Māmoe 0505 Ngāti Manawa 1105 Moriori 0506 Ngāi Tai (Tauranga Moana/Mātaatua) 1106 Ngāti Mutunga (Wharekauri/Chatham Islands) 0507 Tūhoe 1107 Rangitāne (Te Waipounamu/South Island) 0508 Whakatōhea 1108 Ngāti Rārua 0509 Te Whānau-a-Apanui 1109 Ngāi Tahu / Kāi Tahu 0510 Ngāti Whare 1110 Ngāti Tama (Te Waipounamu/South Island) Te Tai Rāwhiti (East Coast) Region 1111 Ngāti Toarangatira 0600 Te Tai Rāwhiti (East Coast) Region not (Te Waipounamu/South Island) further defined 1112 Waitaha (Te Waipounamu/South Island) 0601 Ngāti Porou 1113 Ngāti Apa ki Te Rā Tō 0602 Te Aitanga-a-Māhaki 0603 Rongowhakaata 0604 Ngāi Tāmanuhiri

20 REGISTRATION FORM FOR DISABILITY SERVICES

Massey University is committed to providing equity of access to the educational Impairment/Disability/Medical condition opportunities it offers to students. Disability Services at Massey University can Please tick the box(es) which most closely describe your situation: provide a range of services to support the participation of students. Please complete this registration form if you wish Massey University to be aware of a disability issue „„Deaf and/or you are seeking access to available services. „„Blind If you have any questions prior to the completion of the registration form please Speech contact Disability Services directly on (06) 350 5959 or e-mail us at: „„ [email protected] „„Specific learning disability (eg Dyslexia) Massey Student ID number (if known): „„Medical „„Physical „„Head injury Date of birth Day Month Year „„Neurological Surname or family name „„Hearing „„Vision „„RSI/OOS First or given name(s) „„Mental health/Psychological „„Aspergers / ASD Mailing address „„Other (please describe)

Postcode

E-mail Areas of support In which of the following areas are you likely to experience barriers to study at Phone (daytime) ( ) Massey: „„Seeing/reading print material Supporting information „„Accessing building/facilities/equipment This registration form must be accompanied by supporting documentation from a Hearing in lectures/classes doctor, therapist or other appropriate health or allied professional. „„ Documentation supplied should address the following: „„Taking notes in lectures/classes • Confirmation of the identified impairment, disability or medical condition. „„Tests and examinations • The nature of the impairment, disability or medical condition i.e. whether it is Structuring/organising study temporary or permanent, constant, fluctuating, improving or degenerating. „„ Specific study activities/tasks • The likely impact of impairment, disability, medical condition on chosen course of „„ study. „„No barriers anticipated • Recommendations on particular services or supports to address the impact of the Other barriers (please complete Additional Information section on the next page) identified impairment, disability or medical condition in the tertiary environment. „„ Registration forms received without any supporting information cannot be processed and will be returned with a request for the missing Page 1 of 2 – please turn over information.

21 REGISTRATION FORM FOR DISABILITY SERVICES

1. Additional information 2. Confidentiality Please use this section to outline any further information you wish to provide as part Massey University undertakes to protect the confidentiality of personal information of your registration with Disability Services. which you provide as part of your enrolment, in accordance with the provisions of the Privacy Act 1993. The uses and protection of personal information are specified in the declaration which you sign on your Enrolment Application form.

Signed Date

In order to quickly process and respond to your registration with Disability Services, it is highly recommended that you send the Disability Registration form (and the supporting information) separately from your Massey University enrolment application. Please send completed Disability Registration Forms to: Centre for Teaching and Learning Disability Services Massey University Private Bag 11 222 Manawatu Mail Centre Palmerston North 4442

Office use only

Campus: ALB / WTN / PN Mode: INT / EXT / MIX Enrolled: FT / PT / LFT

Student Status: CUR / NEW Documents supplied: YES / NO Supports required: YES / NO

Contact required: YES / NO Date contacted:______

Entered by:______Date:______Notes:

22 23 Contact or follow us WHAKAPĀ MAI

0800 MASSEY (627 739)

ENGINE.AC.NZ

FACEBOOK.COM/MASSEYUNIVERSITY

TWITTER.COM/MASSEY_UNI

SE/13/11