application form For

international students

NOTE: THERE IS NO REFUND FOR WITHDRAWALS ONCE A PROGRAMME OR COURSE HAS STARTED

This application form is for International Students applying to study at Wintec. of their Visa plus one week. Proof of current Medical and Travel Insurance is
In order for your application to be considered, please complete ALL sections required before your enrolment can be finalised.
of this form, attach the required verified documentation and sign and date the
declaration at the end. As programmes are very popular, please apply early Wintec
while spaces are still available. Private Bag 3036, Hamilton, New Zealand
Phone: +64 7 838 6399
Medical and Travel Insurance: It is compulsory for all International Students Fax: +64 7 858 0246
to have appropriate and current Medical and Travel Insurance while studying Email: international@wintec.ac.nz
in New Zealand. It is a Wintec requirement for International Students to be Web: www.wintec.ac.nz/international
covered from the day the student leaves their home country to the expiry date

section one - personal details

1.1 Title Mr Mrs Ms Miss Other OFFICIAL USE ONLY

1.2 First Name(s) I D N U M B E R

hassen
1.3 Family Name (please PRINT your name as shown on your passport)

Al Shamrie barcode here

1.4 Preferred First Name

hassen
1.5 Date of Birth 1.6 Gender

1d 1d 11
m 20
y 03
y Male Female

section tHREE - AGENT CONTact details*

m
Please attach a verified copy of your passport or birth certificate
If you are not applying through an agent please go to Section Four.
1.7 Country of citizenship 3.1 Agent’s company name:

1.8 Ethnicity 3.2 What is the agent’s name?

3.3 Wintec authorised Agent number

section tWO - YOUR contact details

(Authorised agents can send scanned copies as long as the email
Please ensure this is kept up- to-date at all times and advise us of any changes. states they are true copies)
3.4 What is the agent’s email address?
2.1 What is your current address?
Unit number/street number and name

* Note: Original certified copies of documents are preferred, however

Suburb photocopies, fascimilies or emailed scanned documents are acceptable if
of a high quality and are legible. You will be required to produce original
certified documents upon arrival in New Zealand for audit purposes and/or
City/Town if the electronic copies you have supplied are illegible.

Country Tick if this is your main postal address section FOUR - WINTEC SERVICES

2.3 How can we contact you? 4.1 Would you like Wintec to organise accommodation for you?:

Home phone ✔ Yes No

905523398646
4.2 If yes, please indicate your accommodation preference:
Mobile
✔ Homestay Hostel

Work 4.3 Would you like Wintec to arrange an airport pick-up for you?

Email
Yes ✔ No
hassenabdo174@gmail.com

2.4 Who is your emergency contact?

Name aied

Relationship to you

Telephone
section fIVE - ENGLISH STUDY section SEVEN - English proficiency CONT.

5.1 Do you wish to study English (ESOL) before you study a mainstream 7.5 Have you studied in New Zealand before? eg Language School,
programme? Secondary School, Polytechnic or University
Yes - go to 5.2 No - go to Section Six. Yes No
5.2 How many weeks?
7.6 If YES, name of institution
0
7.7 Dates attended From To
5.3 Preferred start date 5.4 Preferred end date

section EIGHT - SECONDARY SCHOOL STUDIES

5.5 Do you want to study ESOL during Summer School (Dec / Jan)?
Yes No 8.1 Please provide verified official documentation of academic results
for all qualifications

section SIX - PROGRAMME SELECTION New zealand secondary

name of school
6.1 What mainstream programme(s)/Qualification(s) at Wintec are you
HIGHEST
wanting to do? qualification

year start year finish

for office use only
name of mainstream programMe(s)
programme code
Successfully completed Yes No
1

Pathway: overseas high school

2 name of school baghdad

Pathway: country turky

highest
3
qualification 88
Pathway:
year start 2018 year finish 2020

Successfully completed Yes No

6.2 Preferred mainstream programme start date if offerred a place?

February April/May July October / November

(Please check intake is correctly selected: www.wintec.ac.nz/courses) section nine - tertiary STUDIES

6.3 Are you applying for transfer of credit? If yes, complete an application
form when you arrive at Wintec. You must also provide learning 9.1 Please provide verified official documentation of academic results
descriptors/learning outcomes of previous study with this application for all qualifications
for assessment. Yes No
university / higher education / foundation / language school

name of school

section SEVEN - English proficiency country

qualification
7.1 What is your first language?
year start year finish
arabic
Successfully completed Yes No
7.2 Have you ever had your English language abilities or proficiency
tested? name of school

country
✔ Yes ✔ No Date of Assessment
qualification

7.3 What level was your English language assessed at? year start year finish
(Please attach a verified copy of your results)
Successfully completed Yes No
score
score: TOEFL Computer based Paper based
9.2 What is the highest tertiary qualification you hold? (please tick one)
score: TOEIC Computer based Paper based No tertiary qualification
IELTS:
Vocational qualification (Trade, NZ Certificate)
score: score:
Reading Listening
Certificate
score: Writing score: Speaking
Diploma
Overall score:
Graduate Certificate/Diploma
NCEA: level: Score:
Bachelors degree
Other: level: Score:
Postgraduate qualification

7.4 If you have not sat an English proficiency test in the last 3-4 months, Masters
do you require a Wintec internal language assessment?
Other
Yes No
Please attach a verified translation of your results.

section ten - statistical information section thirteen - student declaration
- all students must read the following
10.1 How do you hear about Wintec? Please tick one information and sign

Embassy/NZ Trade and Enterprise Agent Personal information collected, held and exchanged by Wintec is required
to enable it to comply with the Education Act 1989 and its role as an
Friends Family member educational provider. The collection, use, storage, exchange and update of
personal information will be in accordance with the Privacy Act 1993.
Education fair/expo Advertisment
I will make myself familiar and comply with provisions of Wintec’s Policies
and Regulations obtainable from the Library, Faculty/ Schools or Wintec
Other NZ education provider NZ High School website, www.wintec.ac.nz, including Academic Regulations, Occupational
Health & Safety, Regalia (Graduation), Smokefree, Student Complaints,
English language school Internet Student Computer Use and Programme Regulations
Other Key points to include:

10.2 What was (or will be) your main activity on the 1st of October in the i) Students have the right to access and correct any information held
about them.
year before you start your study?
ii) Within Wintec, relevant personal information will be available to
Living outside of New Zealand Living in New Zealand
staff responsible for enrolment, for establishing and maintaining
records, providing tuition, programmes and academic support,
If living in New Zealand, please specify providing student services (including Students’ Association), and for
Secondary school student Tertiary student maintaining discipline and order.

Wintec is also required to collect and store information from

iii)
Wage/ salaried worker Non-employed this form to comply with the requirements of the Ministry of Education
(student statistical returns), New Zealand Qualifications Authority
(Record of Learning registration and Unit Standard outcomes),
section eleven - impairments Ministry of Social Development (confirmation of enrolment and
academic outcomes), Immigration New Zealand (if you are not
11.1 Do you live with the effects of a significant injury, long-term illness, or a New Zealand citizen or permanent resident) and other educational
disability? organisations and agencies supporting students through scholarships
and awards. In addition, when required by statute, Wintec releases
Yes No information to Government agencies such as the New Zealand Police,
Department of Justice, Ministry of Social Development, and the
11.2 If yes, please indicate by ticking the appropriate box below Accident Compensation Corporation (ACC).

Deaf Hearing Impairment a) I have read and understood the guideline above of how Wintec
will apply the Privacy Act, and I authorise Wintec to collect, use
Blind Vision impairment and disclose personal information about me in accordance with
that outline and the Privacy Act 1993.
Specific learning disability Medical
b) I authorise any agency holding the source of any information I
have provided on this form to release that information to Wintec
Head injury Mental health
upon request.
Mobility/physical Speech impairment c) I declare that the information I have supplied in this form
and any attached documentation is true and complete and
Other - please state I acknowledge that Wintec may suspend my enrolment if false
information has been supplied or required information is not
supplied by the due date.
section Twelve - criminal convictions
d) I will make myself familiar and comply with provisions of
Wintec’s Policies and Regulations obtainable from
This information is legally required to provide to any employers of students
the Library, Faculty/Schools or the Wintec website,
who are placed with them for work experience, clinical, or practical www.wintec.ac.nz, including Academic Regulations, Occupational
components of the students’ programme of study. Wintec must make you Health & Safety, Regalia (Graduation), Smokefree, Student
aware that if you have a criminal record, and you are unable to complete Complaints, Student Computer Use and Programme Regulations.
a practical component of the programme, you may not be eligible for the
qualification at the end of the course. Any students enrolling with a criminal e) Please Note: that your name, date of birth and residency as
record should contact with the Student Enrolment and Information Centre. entered on this enrolment will be included in the
National Student Index, and will be used in an Authorised
Information Matching programme with the New Zealand Birth
12.1 Have you ever been convicted of or have a pending conviction for any Register. For further information please see
offence against the law (apart from minor traffic convictions)? http://www.nsi.govt.nz/ima

Yes No f) Wintec may contact you via telephone, post, email and/or text
message regarding your enrolment or Wintec’s services, news
12.2 If yes please complete the consent to disclosure of information which or events.
can be found online at www.wintec.ac.nz/forms and attach to this form.

To be signed by the applicant

Application checklist Your Signature

Answered ALL questions? Attached

✔ a verified copy 7/11/2020
Date
of your English Proficiency
Attached your verified copies Test results, if required? (DO
of documents proving Legal NOT send originals, only To be signed by a parent/guardian for applicants under the age of 18 years only
Name, Date of Birth and verified copies). Parents/guardians signature
Residency status? (DO NOT
send originals, only verified Signed and dated this form?
copies).

Attached your results if Date

required by programme entry
criteria? (DO NOT send
originals, only verified copies).