Food and Fibre
Taratahi Enrolment Form
OFFICE USE ONLY
PROGRAMMES
The programmes are offered at the Taratahi Agricultural
Training Centre, 529 Cornwall Road, Masterton.
Emergency Contact Person:
Contact
Relationship to you
Phone
Please supply us with current contact information so that we can
keep you informed of your application status.
Home Phone
Mobile
Email
Work Phone
Do you have a preferred contact method?
Post Email Text (mobile)
Any
Street Address
Suburb
Town/City
Postcode
Mailing Address while studying at UCOL
Yes No
If Yes, your Student ID
National Student Index (NSI) Number (if known)
Date of Birth:
Day Month Year
Title: Mr Ms Mrs Miss
Other, please specify
Have you previously enrolled at UCOL, Manawatu Polytechnic,
Wanganui Regional Community Polytechnic or Wairarapa
Community Polytechnic before?
Legal First Name(s)
Legal Surname
Preferred Name(s)
Female
Legal Gender: Male
If you have previously enrolled at UCOL, Manawatu Polytechnic,
Wanganui Regional Community Polytechnic or Wairarapa Community
Polytechnic under a different name, what was that name?
1 PERSONAL INFORMATION
2
Intake Status
Citizenship & Residency Status:
New Zealand Citizen
Australian Citizen/Permanent Resident
New Zealand Permanent Resident
Other, please specify
What ethnic group(s) do you belong to?
If you identified as New Zealand Maori, please specify Iwi
SECONDARY SCHOOL EDUCATION
Name of last secondary school attended:
3
Which years did you study from at your last secondary
school?
to
Please select your programme choice below:
You must be 18 years or over to enrol into a Fibre and Food programme at Taratahi Agriculture Training Centre
Taster - General Farming (1 week)
Taster Dairy or Apiculture (2 weeks)
Agriculture Contracting (6 weeks)
Gender Diverse
SECONDARY SCHOOL EDUCATION
(continued)
No formal secondary qualification
14 or more credits at any level
NCEA Level 1 or School Certificate
NCEA Level 2 or Sixth Form Certificate
University Entrance
NCEA Level 3 or Bursary or Scholarship
Overseas qualification (includes International
Baccalaureate and Cambridge Exams)
Other - specify
4
What is the highest level of achievement you hold from a
secondary school? (Please tick one box only)
Please mail completed form to:
UCOL Information Centre
Private Bag 11022
Palmerston North
Freepost 460
Or drop it into one of our Information Centres:
Cnr of Princess and King Streets, Palmerston North
143-159 Chapel Street, Masterton
16 Rutland Street, Wanganui
Contact us:
0800 GO UCOL
0800 46 8265
Website: www.ucol.ac.nz
Email: enquiry@ucol.ac.nz
June 2020 v6
PRIOR ACTIVITY
Please tick only one box.
Secondary School student
Self-employed
Private Training Establishment student
Non-employed or beneficiary (excluding retired)
University student
House-person or retired
Overseas - specify:
Wage or salary worker
Polytechnic/Institute of Technology student
Wananga student
5
What was your main activity or occupation in New Zealand on
the 1st October prior to the date of your programme starting?
Blind
Specific learning disability
Mobility
Vision impaired
DISABILITY DETAILS
Do you live with the effects of an injury, long-term illness or
impairment?
Yes No
If yes, please indicate your condition/disability by ticking the
boxes that apply to you.
Deaf
Speech
Hearing impairment
Psychological/
Psychiatric disability
Medical - specify:
Other - specify:
UCOL reserves the right to discuss with you and your medical
practitioner any medical conditions / disabilities that may imapct on
you successfully completing the programme/s or impacting on your
safety.
6
Signature Date
Day Month Year
7 ACKNOWLEDGEMENT & DECLARATION
I hereby apply for admission and enrolment at UCOL and I understand and
agree to the following:
a)
b) That my enrolment at UCOL is subject to UCOL sending me a
Confirmation Letter.
c) That if I receive a UCOL Confirmation Letter I will participate in course/s
I am enrolled in and use my best efforts to successfully complete those
course/s.
d) I undertake to comply with all UCOL’s statutes, policies and procedures.
(these are available through the UCOL website www.ucol.ac.nz).
e) UCOL collects and stores the above information about you relating to
your course. In signing the Food and Fibre Taratahi Enrolment Form, you
authorise the collection and holding of this information.
Under the Privacy Act 1993 you may ask UCOL to provide you with
copies of the information it holds about you. If you disagree with any
such information you may ask to have it corrected.
f) UCOL can use any photographs/videos and/or recordings taken of me for
the purpose of marketing and media during and after my enrolment at
UCOL. I agree to sign other documents required by UCOL for this purpose
(if required).
g) That the information I have given UCOL is true, and complete in
all respects.
h) I acknowledge that the Taratahi Agriculture Training Centre is a drug,
alcohol and smoke-free campus.
i) That I have read, I understand and I agree to the Acknowledgment
& Declaration section of this Food and Fibre Taratahi Enrolment Form.
As soon as UCOL receives my Food & Fibre Taratahi Enrolment Form
and verified proof of my identity (e.g. passport or birth certificate), I have a
conditional contract to study at UCOL.
click to sign
signature
click to edit
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