Micro Credential Enrolment Form

Name | Ratou Ingoa(Required)

First Names | Tōu Ingoa Tuatahi Last Name | Tōu Ingoa Whakamutunga

Preferred first name | Tōu Ingoa hiahia ake

Preferred First Name

Previous names known by | Tōu Ingoa o mua

First Names | Tōu Ingoa Tuatahi Last Name | Tōu Ingoa Whakamutunga

Are you a New Zealand citizen or Permanent resident?(Required)

You need to be a New Zealand citizen or a Permanent resident of New Zealand to enrol at Land Based Training.

Preferred Title | Tōu taitara hiahia ake(Required)

Gender | Ira tangata(Required)

Male

Female

Diverse

Date of birth | Tōu ra whanau(Required)

Email | Tōu Īmera(Required)

I.R.D Number

NSN Number (if known)

Address | Tōu Wāhitau(Required)

Address | Tōu Wāhitau City | Te taone ZIP / Postal Code Country | Te whenua

Day Time Phone | Tōu waea I te ra(Required)

Evening Phone | Tōu waea I te po

Mobile | Tōu waea pūkoro

Next of Kin | Tōu whanaunga

Name | Ratou Ingoa(Required)

First Names | Tōu Ingoa Tuatahi Last Name | Tōu Ingoa Whakamutunga

Relationship to You |(Required)

Phone | Ratou waea(Required)

Address | Tōu Wāhitau(Required)

Address | Tōu Wāhitau City | Te taone ZIP / Postal Code Country | Te whenua

What Programme are you enrolling into?(Required)

What location do you intend to study at?(Required)

Do you intend to study... | Pehea tōu whiriwhiri ako...(Required)

Full Time

Part Time

What date are you planning to start your Programme with LBT?

Have you studied with Land Based Training before? | I ako koe ki te LBT I nga tau e mua(Required)

Yes | Āe

No | Kaore

How did you hear about us? | I pehea koe I ako ai mo matou?(Required)

If you selected other please let us know where you heard about us... |(Required)

Declaration of Prior Achievement: Please list below any qualifications or certificates that you have achieved to date. This must also include any qualifications recently completed and yet to be confirmed. | Te Whakapuakanga o te Paetae o Mua: Tuhia ki raro nga tohu tohu, tiwhikete ranei kua tutuki i a koe ki tenei ra(Required)

Year Achieved

Qualification/Certificate

Please click the (+) button to add additional rows

What was the name of the last secondary school you attended? | He aha te Ingoa o tōu kura tuarua whakamutunga?(Required)

What was your last year at secondary school? | He aha te tau I oti ia koe I te kura tuarua?(Required)

What is the highest level of achievement you hold from Secondary school? | He aha te tohu o to kura teitei?(Required)

Will this be the first year you have ever enrolled in a University, Polytechnic, College of Education, Private Training Establishment, or Wānanga either in New Zealand or overseas since leaving school? Do not include enrolments in STAR, community or hobby classes | Koinei tonu to tau tuatahi I nga Whare Wananga o Aotearoa, o Tāwāhi ranei mai I te wa o te kura tuarua? Kati nga STAR, community me he hobby akoranga.(Required)

Yes | Āe

No | Kaore

Attach verified ID here |

This must be a Passport, Birth Certificate or Marriage Certificate to be an acceptable form of ID.

Max. file size: 100 MB.

Do you need LBT to order a Birth Certificate for you?

Yes

No

For us to move forward with ordering a birth certificate on your behalf please provide the following information:

Place of Birth

Mothers Name

First Last

Fathers Name

First Last

Privacy – Land Based Training collects and stores information from this form to:

• Manage the business of Land Based Training (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 Land Based Training 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 Land Based Training holds about you and request to correct any errors in that information. To do so, contact Quality on [email protected]

NB: The Privacy Act 2020 has the stated aim of protecting the privacy of individuals. It also governs the collection, use, storage and disclosure of personal information. The Privacy Act requires Land Based Training to collect, hold, handle, use and disclose personal information in accordance with the twelve information privacy principles in the Act

Supply of Information to Government Agencies and Other Organisations

Land Based Training 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 Land Based Training to:

• Administer the tertiary education system, including allocating funding and the administration of 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 2022. 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.

Data storage – 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.

When required by law, Land Based Training 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. Land Based Training’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 Land Based Training regarding attendance, academic integrity and progress, conduct and use of information systems.

Student Images Release

I hereby give Land Based Training permission to use my image in any publicity, promotional or marketing material

I do NOT give Land Based Training permission to use my image in any publicity, promotional or marketing material

Please Select ONE of the above options.

Comments

This field is for validation purposes and should be left unchanged.

Micro Credential Enrolment Form

Next of Kin | Tōu whanaunga

Contact Info