Otago Polytechnic

OFFICE USE ONLY

Application Form
D une din C a m pus C e ntra l Ota go C a m pus Auc kla nd C a m pus
Forth Street, Private Corner Erris & Ray Streets, Level 2, 350 Queen Street,
Bag 1910, Dunedin, PO BOX 16, Cromwell, PO BOX 5268, Auckland,
9054, New Zealand 9342, New Zealand 1141, New Zealand

Are you:

a New Zealand Citizen a New Zealand Resident / Permanent an Australian Citizen or Permanent Resident
Resident
a citizen of another country an agent applying on behalf of a customer
Nationality (as shown in passport)

1. Your Details

First name Last name (family name)

Middle names Preferred name

Previous name If you have ever been known by a name other than the one listed in this application. Date of Birth
For example: the name you used before you were married.)

What is your gender? Female Male Diverse Which region of NZ do you normally live in?

I a m N e w Z e a la nd M a ori To which iwi do you belong? (Identify up to three) E thnic ity

N Z QA/N S I num be r (if you know it) Ota go Polyte c hnic ID (if you studied here before)

Email address Phone number

Posta l a ddre ss:

Town Postcode Country

If you know your posta l a ddre ss while studying:

Town Postcode Date you move in

1 .b E m e rge nc y c onta c t

Their name Their relationship to you (for example: mother, uncle)

Their phone number Their email address

2. Stud y O p tions

What is your intended career? Example: Electrical Engineer

Our progra m m e s a re ta ught in E nglish. If English is not your first language, you need to show us that you meet the E nglish La ngua ge re quire m e nts for the
programme you want to study.
Ple a se tic k the box tha t a pplie s to you:

English is my first language English is NOT my first language

Please note: If you have NCEA Level 3 University Entrance you don’t need to provide evidence of English language skills.
Find out more about our English Language requirements
If you do not meet the English requirements, you can study English with us first.
Find out about our English Language certificates

Whic h progra m m e do you wish to a pply f or?

First choice Example: Bachelor of Engineering Technology

Second choice

Third choice

Part-time Full-time

Whic h sta rt da te would you pre f e r? Check the dates available for the programme you wish to apply for at www.op.a c .nz

Start date / /
Day Month Year

Whe re would you like to study? Not all programmes are available by distance, online or at all campus locations. Check the options at www.op.a c .nz

Dunedin Central Otago Auckland (International students only)

Distance Online Other
Capable NZ

International students only

If you ha ve a n a ppointe d a ge nt, ple a se provide the ir de ta ils:
Agent Stamp

Contact person Contact phone number

Company Email

3. What you need to p rovid e to us

The e ntry re quire m e nts f or the progra m m e you a re a pplying f or c a n be f ound on the progra m m e inf orm a tion pa ge on the we bsite . It is your
responsibility to supply us with sufficient information to support your application, including verified evidence of all your qualifications, awards and grades or NCEA credits
achieved.

Wha t a re you c urre ntly studying? (le a ve bla nk if not studying)

List subjects here:

Wha t a re your c urre nt qua lif ic a tions:

Institution Qualification Grade/Mark/Credits (if Year

applicable)

4. Ministry of Ed ucation Q uestions

This information is required by the N e w Z e a la nd Gove rnm e nt

Is this your f irst ye a r of te rtia ry study? Yes No If no, what year did you first
enrol?
Wha t wa s your M AIN a c tivity or oc c upa tion on 1 Oc tobe r in the ye a r prior to your pla nne d study?

House person or retired Non-employed or beneficiary (ex retired) Overseas (irrespective of occupation)
Polytechnic student Private Training Establishment student Secondary school student
Self-employed University student Wage or salary worker
Wananga student

Wha t is the highe st a wa rd you c urre ntly hold f rom se c onda ry sc hool?

14 or more credits at any level NCEA Level 1 or School Certificate NCEA Level 2 or 6th Form Certificate
NCEA Level 3 or Bursary or Scholarship No formal secondary school qualification Not known
Other Overseas qualification University Entrance

N a m e of the la st se c onda ry sc hool you a tte nde d (sta te "ove rse a s"
if a pplic a ble )

Whe n wa s/will be your la st ye a r a t se c onda ry sc hool?

H a ve e ithe r of your pa re nts e ve r studie d a t te rtia ry le ve l (unive rsity, polyte c hnic or othe r highe r e duc a tion institution) ?
Yes No

5. Stud ent Sup p ort

We have a team of professionals that are dedicated to supporting you through your journey with us. Support areas include disability, learning advice, Maori and Pasifika,
emotional and mental health, wellbeing, and anything else you feel will impact on your study.

Would you like us to contact you to chat about your needs? Yes No

If yes, please tell us what support you will need

In an emergency, will you need help to leave the building? Yes No

(Inte rna tiona l stude nts only) C om pulsory he a lth a nd tra ve l insura nc e

The Code of Practice for the Pastoral Care of International Students requires all international students to have comprehensive health and travel insurance. Appropriate
travel and medical insurance is a condition of your student visa. Our recommended and preferred supplier is Uni-Care, and we can arrange this for you.

6. Mark eting Information

How did you find out about this programme? Tick as many that apply:

Polytechnic prospectus/brochure Polytechnic liaison person School Careers Advisor School subject/transition teacher
Friend or family member Work or business colleague Recruitment agent Careers service
Polytechnic open day Expo Internet/www Newspaper
Radio Magazine Television News story in the media
Next subject/programme in your YouTube/Facebook/Twitter
course

7. Declaration

By signing below you agree to our terms and conditions (www.op.ac.nz/students/important-information/terms-and-conditions/)

Signature

Date / /
Day Month Year