APPLICATION FORM
WITT Enrolment Procedure
Progress (part 1 of 4)
1. PERSONAL DETAILS
Home Phone:
Work Phone:
Mobile:
Email:
2. PROGRAMME DETAILS
Name of programme/course you are applying for:
Start Date:
Option 1:
If you are unsure as to which programme is best for you, please list the programmes/careers you are interested in:
NZQA or National Student Number (NSN) (if known):
WITT Student ID (if known):
Have you enrolled at the Western Institute of Technology at Taranaki before?
Yes
No
Mr
Mrs
Miss
Ms
Legal Surname:
Legal First Names:
Previous Name:
Gender:
Date of Birth:
Male
Female
Postal Address:
Suburb
Town/City
Postcode
Country
Option 2:
Option 3:
Do you intend to study
part-time
full-time
Unsure