application form - Wintec

SV01
APPLICATION FOR ACCOMMODATION 2014 — FULL YEAR, SEMESTER A OR B
OFFICE USE ONLY
Date Received
App Fee
Contract Consent Form Con Deposit /
Activity Fee
Please complete and return this form
along with the personal evaluation
form to:
WINTEC Student Village
PO Box 103
Hamilton 3240
Attach two recent
passport sized photos
(head and shoulders)
COMPULSORY
Student ID:
PLEASE COMPLETE BOTH SIDES OF THIS FORM
SURNAME _______________________________________________
FIRST NAME _____________________________________________
USUAL NAME ____________________________________________
DATE OF BIRTH _____/______/______ AGE ______
GENDER: MALE FEMALE
MOBILE_________________________________________________
FAX ___________________________________________________
EMAIL __________________________________________________
CURRENT HIGH SCHOOL (if currently attending high school)
_______________________________________________________
PERMANENT/HOME ADDRESS
_______________________________________________________
_______________________________________________________
_______________________________________________________
CORRESPONDENCE ADDRESS
_______________________________________________________
ETHNICITY
New Zealander/Pakeha
Maori/New Zealander
South East Asian
Other (please specify)
Indian
Pacific Islander (specify)
_______________________
Australian
_______________________________________________________
_______________________________________________________
HOME PHONE ____________________________________________
_____________________________________________
(used for statistical purposes only)
ARE YOU A NEW ZEALAND CITIZEN/PERMANENT RESIDENT? YES / NO
Parents/Caregiver Contact Details:-
SURNAME _______________________________________________
FIRST NAME _____________________________________________
CONTACT ADDRESS
_______________________________________________________
_______________________________________________________
MOBILE: ________________________________________________
HOME PHONE: ___________________________________________
EMAIL: _________________________________________________
RELATIONSHIP: __________________________________________
(i.e. Father, Mother, Uncle, Grandmother)
Alternative Emergency Contact Details:-
SURNAME ______________________________________________
FIRST NAME _____________________________________________
CONTACT ADDRESS
_______________________________________________________
_______________________________________________________
MOBILE: _______________________________________________
HOME PHONE: ___________________________________________
EMAIL: _________________________________________________
RELATIONSHIP: __________________________________________
(i.e. Father, Mother, Uncle, Grandmother, Friend)
Course Information:-
COURSE ATTENDING ________________________________________
________________________________________________________
(i.e. Bachelor of Media Arts, Certificate in Electrical Engineering)
SCHOOL OF STUDY ________________________________________
_______________________________________________________
(i.e. School of Health, School of Trades, Engineering and Construction)
COURSE START DATE FOR 2014 ____________________________
COURSE FINISH DATE FOR 2014 _____________________________
WHICH CAMPUS BASED AT:_____________________________________

Health Information:
DO YOU HAVE ANY PSYCHIATRIC, MEDICAL, ALLERGY, OR DIETARY
RELATED CONDITIONS? (please indicate)
If yes, please specify and attach a letter explaining
NO YES condition, outlining special needs and a medical certificate
for any dietary requirements
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
DO YOU REQUIRE ANY SPECIAL ASSISTANCE OR HAVE ANY OTHER PER-
SONAL REQUIREMENTS? (please circle)
NO
YES
If yes, please specify and attach a letter explaining
condition and outlining special needs.
_____________________________________________________________
_____________________________________________________________
Please list any achievements you have attained:
(i.e.1st XI Hockey Captain, School Ball Committee, Kapa Haka,
“Distinction” in Australasian High School competition, Sports Representative
team other personal achievements.
ACADEMIC ACHIEVEMENTS _________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
SOCIAL/CULTURAL ACHIEVEMENTS ___________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
SPORTING ACHIEVEMENTS __________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Have you applied to study at any other institution next
year?
(please circle) If yes, please indicate your order of preference
(i.e. Wintec 1, Waikato Uni 2, Auckland 3, etc)
NO
YES
________________________________________________________
Room Placement:
Please indicate your preferences regarding the following areas accurately
to help us with room allocation. Please be aware that certain
area’s (i.e. single sex, Kaupapa Maori) will only be available if the demand
exists.
YES NO UNDECIDED
SINGLE SEX AREA
________________________________________________________
Please state any relevant information below which
would support your application:
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Please indicate what accommodation will be
required in 2014:
Semester A
Semester B
Full Year
_______________________________________________________
(Continue on separate sheets if necessary_
I, the undersigned, declare that the information I have provided on this form is true and accurate to the best of my knowledge. I acknowledge that
the Waikato Institute of Technology (Wintec) Student Residence Trust will rely on this information when deciding whether to offer me a place in
Wintec Student Village. I understand that if offered a place, providing information on this form which I know to be incorrect will be grounds to terminate
my Residence Contract at any time. I understand that the Waikato Institute of Technology Student Residence Trust will use the information I
have provided on this form in accordance with the Privacy Act 1993 and I accept that from time to time said Trust may be required to disclose relevant
information contained on this form to agents of the Trust for the purpose of providing a safe living environment for myself and others.
I give permission for the Residential Manager to access my academic learning and the staff of Wintec Student Village to seek medical advice in the
case of a medical emergency on my behalf.
APPLICANTS SIGNATURE: ________________________________________ DATE: _____________________________
What do I do now?
1. Make sure each section has been completed on this form and that you have read and signed at the bottom section of this page.
2. Attach the $150 Application Fee to this form along with two recently taken passport sized photos.
3. Make sure you complete the top section of the personal evaluation form and give it to your referee along with this application form and
the self addressed envelope. Ask them to send both forms away to: the Residential Manager, Wintec Student Village
PO Box 103 Hamilton 3240.

INFORMATION SHEET
181 Collingwood Street, PO Box 103, Hamilton 3240
Telephone: 07-834 9224 Fax: 07-834 9221
HOW TO APPLY
1.Complete the attached form
(front and back) and return with
the $150.00 Application Fee
and two recent passport sized
photos (head and shoulders).
2.Hand the attached Personal
Evaluation Form to your referee
along with your application
form and the self addressed
envelope.
3. Ask your referee to complete
the personal evaluation form
and send both forms to:
Wintec Student Village, PO Box
103, Hamilton 3240.
4.Please ensure you have asked
an appropriate person to be
your referee. See the personal
evaluation from for more details.
If we do not receive an
appropriate reference along
with your application, your application
may not be accepted.
WHAT HAPPENS THEN?
You will be notified as to whether
or not you have been accepted
into Wintec Student Village.
If your application is successful
you will be sent a letter offering
you a place in the Village. This
will be accompanied by a Residence
Contract.
Please read all documentation
carefully, complete the contract
and return it to the Village Office
along with a Contingency Deposit
of $840.00 and an Activity Fee
of $75.00.
Direct credit or internet banking
deposits can be made to BNZ,
Hamilton, 020-316-0230048-00,
ref Student Name, SV01 2014.
An advance payment of $280.00
towards your weekly accommodation
charges is due prior to or
on arrival (unless by special arrangement
with the Residential
Manager).
(Please see fee schedule below
for information).
FEES
APPLICATION FEE
There is a non-refundable $150
application fee which covers
printing, postage and processing.
CONTINGENCY DEPOSIT
The Deposit of $840 is refundable
upon departure from the Village
at the end of your tertiary study
year less any personal and community
damages. IF YOU LEAVE
THE VILLAGE BEFORE YOUR TENAN-
CY EXPIRES (IE TO GO FLATTING)
YOU WILL FORFEIT YOUR CONTIN-
GENCY DEPOSIT AND BE LIABLE FOR
RENT UNTIL THE END OF YOUR CON-
TRACT OR PAY A PENALTY OF
$3,000. (This is at the discretion
of the Manager)
ACTIVITY FEE of $75.00
The Activity Levy is nonrefundable
and funds student
village events and/or the purchase
of equipment for resident
use.
ACCOMMODATION FEES
The accommodation fees are set
at $280 per week including meals
and are charged for the duration
of your stay. Residents must continue
to pay during the semester
holiday break and/or if on work
experience even if they are away
from the Village. Regular instalments
can be set up at weekly,
fortnightly, or monthly intervals.
The first instalment is due prior to
or upon arrival at the Village.
RENT IN ADVANCE
Rent is due on Thursdays, 1 week
in advance.
TOTAL FEES
The total fees paid prior to arrival
at Wintec Student Village
(including: Application Fee, Contingency
Deposit, Activity Levy,
and 1st weeks rent are: $1,345.
YEARLY FEES
If you would like to pay for the
full semester it is based on 19
weeks plus, Application Fee, Contingency
Deposit and Activity Fee:
$6,385. (Please confirm full semester
fees with our staff before
making payment.)