New Client Registration Form

Personal Details

Name
Name
First
Last
cancel1 check1 Eight characters minimum cancel1 check1 One lowercase letter cancel1 check1 One uppercase letter cancel1 check1 One number cancel1 check1 One special character
Home Address
Home Address
City
State/Province
Zip/Postal
Company Address
Company Address
City
State/Province
Zip/Postal

Maximum file size: 64MB

Ethnicity

With which of the following ethnic groups do you identify? (You may tick up to three boxes)

Declaration and compliance with the privacy act 1993

Privacy

Educhem collects and stores information from 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 Standards outcomes). Tertiary Education Commission (funding returns), Industry Training

Organisations (funding and academic outcomes), Ministry of Social Development (confirmation of enrolment and academic outcomes), Inland Revenue

Department (student loan rebate interest), Department of Immigration (if you are not a New Zealand citizen or permanent resident) and Agencies who support

particular students through scholarships and prizes, payment of fees or other awards (if you are a recipient of one of these awards). The information is also used

to select students for qualifications, to manage internal administrative processes, and for internal reporting. Information about students may be supplied to, and

sought from, other educational organisations for the purpose of verifying academic records.

In addition, when required by statute, the Institute releases information to Government agencies such as New Zealand Police, Department of Justice, Ministry of

Social Development, and the Accident Compensation Corporation (ACC)

In signing this enrolment form you authorise such disclosure on the understanding Educhem will observe the general conditions governing the release of

information, as set out in the Privacy Act 1993 and the Post-compulsory Unique Identifier Code of Practice. You may see any information held about you and

amend any errors in that information. To do so contact Educhem.

NB: The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires the Organisation to collect, hold,

handle, use and disclose personal information in accordance with the twelve information privacy principles in the Act.

http://www.privacy.org.nz/privacy-act

Fees

In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery.

The Organisation’s policy on withdrawal and refund of fees may be obtained from Educhem

Rules

In signing this enrolment form you undertake to comply with the published Terms and Conditions of the Organisation with regard to attendance, academic

progress, standard of dress, health and safety, behaviour and payment of course invoices. See overleaf for full Terms and Conditions.

Declaration

I declare that to the best of my knowledge all the information supplied on, and with, this enrolment form is true and complete, I agree to abide by the conditions

described above and I consent to the disclosure of personal information as described above.

23:27:32 at 29/05/2024

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