application form - Wintec
application form - Wintec
application form - Wintec
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
SV01<br />
APPLICATION FOR ACCOMMODATION 2014 — FULL YEAR, SEMESTER A OR B<br />
OFFICE USE ONLY<br />
Date Received<br />
App Fee<br />
Contract Consent Form Con Deposit /<br />
Activity Fee<br />
Please complete and return this <strong>form</strong><br />
along with the personal evaluation<br />
<strong>form</strong> to:<br />
WINTEC Student Village<br />
PO Box 103<br />
Hamilton 3240<br />
Attach two recent<br />
passport sized photos<br />
(head and shoulders)<br />
COMPULSORY<br />
Student ID:<br />
PLEASE COMPLETE BOTH SIDES OF THIS FORM<br />
SURNAME _______________________________________________<br />
FIRST NAME _____________________________________________<br />
USUAL NAME ____________________________________________<br />
DATE OF BIRTH _____/______/______ AGE ______<br />
GENDER: MALE FEMALE<br />
MOBILE_________________________________________________<br />
FAX ___________________________________________________<br />
EMAIL __________________________________________________<br />
CURRENT HIGH SCHOOL (if currently attending high school)<br />
_______________________________________________________<br />
PERMANENT/HOME ADDRESS<br />
_______________________________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
CORRESPONDENCE ADDRESS<br />
_______________________________________________________<br />
ETHNICITY<br />
New Zealander/Pakeha<br />
Maori/New Zealander<br />
South East Asian<br />
Other (please specify)<br />
Indian<br />
Pacific Islander (specify)<br />
_______________________<br />
Australian<br />
_______________________________________________________<br />
_______________________________________________________<br />
HOME PHONE ____________________________________________<br />
_____________________________________________<br />
(used for statistical purposes only)<br />
ARE YOU A NEW ZEALAND CITIZEN/PERMANENT RESIDENT? YES / NO<br />
Parents/Caregiver Contact Details:-<br />
SURNAME _______________________________________________<br />
FIRST NAME _____________________________________________<br />
CONTACT ADDRESS<br />
_______________________________________________________<br />
_______________________________________________________<br />
MOBILE: ________________________________________________<br />
HOME PHONE: ___________________________________________<br />
EMAIL: _________________________________________________<br />
RELATIONSHIP: __________________________________________<br />
(i.e. Father, Mother, Uncle, Grandmother)<br />
Alternative Emergency Contact Details:-<br />
SURNAME ______________________________________________<br />
FIRST NAME _____________________________________________<br />
CONTACT ADDRESS<br />
_______________________________________________________<br />
_______________________________________________________<br />
MOBILE: _______________________________________________<br />
HOME PHONE: ___________________________________________<br />
EMAIL: _________________________________________________<br />
RELATIONSHIP: __________________________________________<br />
(i.e. Father, Mother, Uncle, Grandmother, Friend)<br />
Course In<strong>form</strong>ation:-<br />
COURSE ATTENDING ________________________________________<br />
________________________________________________________<br />
(i.e. Bachelor of Media Arts, Certificate in Electrical Engineering)<br />
SCHOOL OF STUDY ________________________________________<br />
_______________________________________________________<br />
(i.e. School of Health, School of Trades, Engineering and Construction)<br />
COURSE START DATE FOR 2014 ____________________________<br />
COURSE FINISH DATE FOR 2014 _____________________________<br />
WHICH CAMPUS BASED AT:_____________________________________
Health In<strong>form</strong>ation:<br />
DO YOU HAVE ANY PSYCHIATRIC, MEDICAL, ALLERGY, OR DIETARY<br />
RELATED CONDITIONS? (please indicate)<br />
If yes, please specify and attach a letter explaining<br />
NO YES condition, outlining special needs and a medical certificate<br />
for any dietary requirements<br />
_____________________________________________________________<br />
_____________________________________________________________<br />
_____________________________________________________________<br />
_____________________________________________________________<br />
_____________________________________________________________<br />
DO YOU REQUIRE ANY SPECIAL ASSISTANCE OR HAVE ANY OTHER PER-<br />
SONAL REQUIREMENTS? (please circle)<br />
NO<br />
YES<br />
If yes, please specify and attach a letter explaining<br />
condition and outlining special needs.<br />
_____________________________________________________________<br />
_____________________________________________________________<br />
Please list any achievements you have attained:<br />
(i.e.1st XI Hockey Captain, School Ball Committee, Kapa Haka,<br />
“Distinction” in Australasian High School competition, Sports Representative<br />
team other personal achievements.<br />
ACADEMIC ACHIEVEMENTS _________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
SOCIAL/CULTURAL ACHIEVEMENTS ___________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
SPORTING ACHIEVEMENTS __________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
Have you applied to study at any other institution next<br />
year?<br />
(please circle) If yes, please indicate your order of preference<br />
(i.e. <strong>Wintec</strong> 1, Waikato Uni 2, Auckland 3, etc)<br />
NO<br />
YES<br />
________________________________________________________<br />
Room Placement:<br />
Please indicate your preferences regarding the following areas accurately<br />
to help us with room allocation. Please be aware that certain<br />
area’s (i.e. single sex, Kaupapa Maori) will only be available if the demand<br />
exists.<br />
YES NO UNDECIDED<br />
SINGLE SEX AREA<br />
________________________________________________________<br />
Please state any relevant in<strong>form</strong>ation below which<br />
would support your <strong>application</strong>:<br />
_______________________________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
_______________________________________________________<br />
Please indicate what accommodation will be<br />
required in 2014:<br />
Semester A<br />
Semester B<br />
Full Year<br />
_______________________________________________________<br />
(Continue on separate sheets if necessary_<br />
I, the undersigned, declare that the in<strong>form</strong>ation I have provided on this <strong>form</strong> is true and accurate to the best of my knowledge. I acknowledge that<br />
the Waikato Institute of Technology (<strong>Wintec</strong>) Student Residence Trust will rely on this in<strong>form</strong>ation when deciding whether to offer me a place in<br />
<strong>Wintec</strong> Student Village. I understand that if offered a place, providing in<strong>form</strong>ation on this <strong>form</strong> which I know to be incorrect will be grounds to terminate<br />
my Residence Contract at any time. I understand that the Waikato Institute of Technology Student Residence Trust will use the in<strong>form</strong>ation I<br />
have provided on this <strong>form</strong> in accordance with the Privacy Act 1993 and I accept that from time to time said Trust may be required to disclose relevant<br />
in<strong>form</strong>ation contained on this <strong>form</strong> to agents of the Trust for the purpose of providing a safe living environment for myself and others.<br />
I give permission for the Residential Manager to access my academic learning and the staff of <strong>Wintec</strong> Student Village to seek medical advice in the<br />
case of a medical emergency on my behalf.<br />
APPLICANTS SIGNATURE: ________________________________________ DATE: _____________________________<br />
What do I do now?<br />
1. Make sure each section has been completed on this <strong>form</strong> and that you have read and signed at the bottom section of this page.<br />
2. Attach the $150 Application Fee to this <strong>form</strong> along with two recently taken passport sized photos.<br />
3. Make sure you complete the top section of the personal evaluation <strong>form</strong> and give it to your referee along with this <strong>application</strong> <strong>form</strong> and<br />
the self addressed envelope. Ask them to send both <strong>form</strong>s away to: the Residential Manager, <strong>Wintec</strong> Student Village<br />
PO Box 103 Hamilton 3240.
INFORMATION SHEET<br />
181 Collingwood Street, PO Box 103, Hamilton 3240<br />
Telephone: 07-834 9224 Fax: 07-834 9221<br />
HOW TO APPLY<br />
1.Complete the attached <strong>form</strong><br />
(front and back) and return with<br />
the $150.00 Application Fee<br />
and two recent passport sized<br />
photos (head and shoulders).<br />
2.Hand the attached Personal<br />
Evaluation Form to your referee<br />
along with your <strong>application</strong><br />
<strong>form</strong> and the self addressed<br />
envelope.<br />
3. Ask your referee to complete<br />
the personal evaluation <strong>form</strong><br />
and send both <strong>form</strong>s to:<br />
<strong>Wintec</strong> Student Village, PO Box<br />
103, Hamilton 3240.<br />
4.Please ensure you have asked<br />
an appropriate person to be<br />
your referee. See the personal<br />
evaluation from for more details.<br />
If we do not receive an<br />
appropriate reference along<br />
with your <strong>application</strong>, your <strong>application</strong><br />
may not be accepted.<br />
WHAT HAPPENS THEN?<br />
You will be notified as to whether<br />
or not you have been accepted<br />
into <strong>Wintec</strong> Student Village.<br />
If your <strong>application</strong> is successful<br />
you will be sent a letter offering<br />
you a place in the Village. This<br />
will be accompanied by a Residence<br />
Contract.<br />
Please read all documentation<br />
carefully, complete the contract<br />
and return it to the Village Office<br />
along with a Contingency Deposit<br />
of $840.00 and an Activity Fee<br />
of $75.00.<br />
Direct credit or internet banking<br />
deposits can be made to BNZ,<br />
Hamilton, 020-316-0230048-00,<br />
ref Student Name, SV01 2014.<br />
An advance payment of $280.00<br />
towards your weekly accommodation<br />
charges is due prior to or<br />
on arrival (unless by special arrangement<br />
with the Residential<br />
Manager).<br />
(Please see fee schedule below<br />
for in<strong>form</strong>ation).<br />
FEES<br />
APPLICATION FEE<br />
There is a non-refundable $150<br />
<strong>application</strong> fee which covers<br />
printing, postage and processing.<br />
CONTINGENCY DEPOSIT<br />
The Deposit of $840 is refundable<br />
upon departure from the Village<br />
at the end of your tertiary study<br />
year less any personal and community<br />
damages. IF YOU LEAVE<br />
THE VILLAGE BEFORE YOUR TENAN-<br />
CY EXPIRES (IE TO GO FLATTING)<br />
YOU WILL FORFEIT YOUR CONTIN-<br />
GENCY DEPOSIT AND BE LIABLE FOR<br />
RENT UNTIL THE END OF YOUR CON-<br />
TRACT OR PAY A PENALTY OF<br />
$3,000. (This is at the discretion<br />
of the Manager)<br />
ACTIVITY FEE of $75.00<br />
The Activity Levy is nonrefundable<br />
and funds student<br />
village events and/or the purchase<br />
of equipment for resident<br />
use.<br />
ACCOMMODATION FEES<br />
The accommodation fees are set<br />
at $280 per week including meals<br />
and are charged for the duration<br />
of your stay. Residents must continue<br />
to pay during the semester<br />
holiday break and/or if on work<br />
experience even if they are away<br />
from the Village. Regular instalments<br />
can be set up at weekly,<br />
fortnightly, or monthly intervals.<br />
The first instalment is due prior to<br />
or upon arrival at the Village.<br />
RENT IN ADVANCE<br />
Rent is due on Thursdays, 1 week<br />
in advance.<br />
TOTAL FEES<br />
The total fees paid prior to arrival<br />
at <strong>Wintec</strong> Student Village<br />
(including: Application Fee, Contingency<br />
Deposit, Activity Levy,<br />
and 1st weeks rent are: $1,345.<br />
YEARLY FEES<br />
If you would like to pay for the<br />
full semester it is based on 19<br />
weeks plus, Application Fee, Contingency<br />
Deposit and Activity Fee:<br />
$6,385. (Please confirm full semester<br />
fees with our staff before<br />
making payment.)