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STUDENT ENROLMENT FORM
Course Name *
Please select from the following list
Contact Details
So we know how to get in touch with you
First Name *
Last Name *
Email *
Primary Phone number *
Secondary Phone number
Address
Enrolment Information
This is needed by the organisations who help fund our courses and make it possible for us to offer them to the Waiheke community. Your name and contact details will not be shared with any other organisation.
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Required
Iwi / Hapu
If you are NZ Maori, what is your iwi and hapu?
English Language status *
What is your first / native language?
Residency Status *
Education / Qualification *
Please note the highest qualification (if any)
Work Status *
Where did you hear about Waiheke Adult Learning
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Agreement
Privacy: Your personal information will be kept on file by Waiheke Adult Learning in accordance with the Privacy Act (1993).  It will not be used in any statistics collated, or, for any unauthorised purpose and all information is filed securely.

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By submitting this form you agree to agree to the Terms and Conditions as detailed at http://wal.org.nz/about/terms-and-conditions/
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