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SV01
APPLICATION FOR ACCOMMODATION 2015
Please complete and return this form
along with the personal evaluation
form to:
OFFICE USE ONLY
App Fee
Contract
Consent Form
Date Received
Con Deposit /
Activity Fee
WINTEC Student Village
PO Box 103
Hamilton 3240
Attach two recent
passport sized photos
(head and shoulders)
COMPULSORY
Student ID:
PLEASE COMPLETE ALL INFORMATION ON THIS FORM
STUDENT VILLAGE (42/21 Week Contract)
WINTEC APARTMENTS (48/24 Week Contract)
SURNAME _______________________________________________
MOBILE_________________________________________________
FIRST NAME _____________________________________________
FAX ___________________________________________________
USUAL NAME ____________________________________________
EMAIL __________________________________________________
DATE OF BIRTH _____/______/______ AGE ______
CURRENT HIGH SCHOOL (if currently attending high school)
GENDER:
_______________________________________________________
MALE
FEMALE
PERMANENT/HOME ADDRESS
_______________________________________________________
_______________________________________________________
_______________________________________________________
CORRESPONDENCE ADDRESS
_______________________________________________________
_______________________________________________________
_______________________________________________________
HOME PHONE __________________________________________
ETHNICITY
European/New Zealander
Indian
Maori/New Zealander
Pacific Islander (specify)
South East Asian
_______________________
Other (please specify)
Australian
_____________________________________________
(used for statistical purposes only)
ARE YOU A:
Domestic Student
International Student
Parents/Caregiver Contact Details:SURNAME _______________________________________________
FIRST NAME _____________________________________________
CONTACT ADDRESS
_______________________________________________________
_______________________________________________________
MOBILE: ________________________________________________
HOME PHONE: ___________________________________________
EMAIL: _________________________________________________
RELATIONSHIP: __________________________________________
(i.e. Father, Mother, Uncle, Grandmother)
Alternative Emergency Contact Details:SURNAME ______________________________________________
FIRST NAME _____________________________________________
CONTACT ADDRESS
_______________________________________________________
_______________________________________________________
MOBILE: _______________________________________________
HOME PHONE: ___________________________________________
EMAIL: _________________________________________________
RELATIONSHIP: __________________________________________
(i.e. Father, Mother, Uncle, Grandmother, Friend)
Course Information:COURSE ATTENDING ________________________________________
________________________________________________________
(i.e. Bachelor of Media Arts, Certificate in Electrical Engineering)
COURSE START DATE FOR 2015 _____________________________
COURSE FINISH DATE FOR 2015 _____________________________
SCHOOL OF STUDY ________________________________________
_______________________________________________________
(i.e. School of Health, School of Trades, Engineering and Construction)
WHICH CAMPUS BASED AT:_________________________________
Health Information:
Please list any achievements you have attained:
DO YOU HAVE A DISABILITY OR DIETARY RELATED CONDITION?
(please indicate)
If yes, please specify and attach a letter explaining condiNO
YES
tion, outlining special needs and a medical certificate for
any dietary requirements
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
DO YOU REQUIRE ANY SPECIAL ASSISTANCE OR HAVE ANY OTHER
PERSONAL REQUIREMENTS? (please circle)
NO
YES
If yes, please specify and attach a letter explaining condition and outlining special needs.
_____________________________________________________________
_____________________________________________________________
(i.e.1st XI Hockey Captain, School Ball Committee, Kapa Haka,
“Distinction” in Australasian High School competition, Sports Representative team other personal achievements.
ACADEMIC ACHIEVEMENTS _______________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
SOCIAL/CULTURAL ACHIEVEMENTS _________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
SPORTING ACHIEVEMENTS _______________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Have you applied to study at any other institution next year?
(please circle)
NO
YES
If yes, please indicate your order of preference
(i.e. Wintec 1, Waikato Uni 2, Auckland 3, etc)
________________________________________________________
Room Placement:
Please indicate your preferences regarding the following areas accurately to help us with room allocation. Please be aware that certain area’s
(i.e. single sex, Kaupapa Maori) will only be available if the demand exists.
YES
NO
UNDECIDED
SINGLE SEX BLOCK / APARTMENT
________________________________________________________
________________________________________________________
Please state any relevant information below which would
support your application:
_______________________________________________________
_______________________________________________________
Please indicate what accommodation will be
required in 2015:
Student Village:
Part Year 9 Feb to 5 Jul
_______________________________________________________
_______________________________________________________
Full Year 9 Feb to 29 Nov
Apartments:
_______________________________________________________
(Continue on separate sheets if necessary)
Full Year 19 Jan to 20 Dec
Part Year 19 Jan to 5 Jul
I, the undersigned, declare that the information I have provided on this form is true and accurate to the best of my knowledge. I acknowledge that the
Waikato Institute of Technology (Wintec) Student Residence Trust will rely on this information when deciding whether to offer me a place in Wintec Student Village. I understand that if offered a place, providing information on this form which I know to be incorrect will be grounds to terminate my Residence Contract at any time. I understand that the Waikato Institute of Technology Student Residence Trust will use the information I have provided on
this form in accordance with the Privacy Act 1993 and I accept that from time to time said Trust may be required to disclose relevant information contained on this form to agents of the Trust for the purpose of providing a safe living environment for myself and others.
I give permission for the Residential Manager to access my academic learning and the staff of Wintec Student Village to seek medical advice in the case
of a medical emergency on my behalf.
APPLICANTS SIGNATURE: ________________________________________ DATE: ___________________________
What do I do now?
1.
2.
3.
Make sure each section has been completed on this form and that you have read and signed at the bottom section of this page.
Attach the $150 Application Fee to this form along with two recently taken passport sized photos.
Make sure you complete the top section of the personal evaluation form and give it to your referee along with this application form and the
self addressed envelope. Ask them to send both forms away to: the Residential Manager, Wintec Student Village
PO Box 103 Hamilton 3240. For the first round of consideration all forms must be received by : 5pm on Friday 31st October 2014.
Please indicate your preferred method of payment of the Application Fee:
Cheque Enclosed
Internet Banking (BNZ, Hamilton, 020-316-0230048-00, ref Student Name, SV01 2015)
181 Collingwood Street, PO Box 103, Hamilton 3240
Telephone: 07-834 9224 Email: studentvillage@wintec.ac.nz
INFORMATION SHEET
HOW TO APPLY
1.Complete the attached form
in
full and return with the $150.00
Application Fee and two recent
passport sized photos (head and
shoulders).
Payment can be
made via cheque or internet
banking to account details below.
2.For New Zealand Domestic Stu-
WHAT HAPPENS THEN?
You will be notified as to whether
or not you have been accepted
into Wintec Accommodation by
end of November 2014.
If your application is successful
you will be sent a letter offering
you a place. This will be accompanied by a Residence Contract, details of the fees for 2015 and what
to do next.
FEES
APPLICATION FEE
There is a non-refundable $150
application fee which covers printing, postage and processing.
CONTINGENCY DEPOSIT
Student Village $870
Wintec Apartments $720
The Deposit is refundable when
your contract is completed less
any personal and community damages. IF YOU LEAVE THE VILLAGE
BEFORE YOUR TENANCY EXPIRES
(I.E. TO GO FLATTING) YOU WILL
FORFEIT YOUR CONTINGENCY
DEPOSIT AND BE LIABLE FOR
RENT UNTIL THE END OF YOUR
CONTRACT OR PAY A PENALTY OF
$3,000. (At Manager’s discretion)
ACTIVITY FEE of $150.00
The Activity Levy is nonrefundable and funds student vil-
dents please provide us with a
Wintec Accommodation, PO Box
copy of the Common Confiden103, Hamilton 3240 by 5pm on
tial Reference Form completed
Friday, 31st October 2014 to be
your school. If we do not receive
considered in the first round of
an appropriate reference, your
applications.
application may not be accepted.
4.Applications received after the
31st October 2014 will still be
3.Send the Application Form and
accepted but placed on a waitlist.
Common Reference Form to:
Please read all documentation
carefully, complete the contract
and return it to Wintec Accommodation along with payment of the
Contingency Deposit and Activity
Fee by 3pm on Friday, 16th January 2015.
Direct credit or internet banking
deposits can be made to: BNZ,
Hamilton,
020-316-0230048-00,
ref Student Name, SV01 2015.
An advance payment of towards
your weekly accommodation
charges will be due prior to or on
arrival (unless by special arrangement with the Manager).
(Please see fee schedule below for
information).
lage events and/or the purchase of TOTAL FEES
equipment for resident use.
The total fees paid prior to arrival
at Wintec Student Village
ACCOMMODATION FEES
(including: Application Fee, ContinStudent Village $290
gency Deposit, Activity Levy, and
(Fully Catered)
1st weeks rent are:
Wintec Apartments $180
Student Village
$ 1,460
(Self-catered)
Wintec Apartments
$ 1,200
The weekly accommodation fee is
charged for the duration of your YEARLY FEES
stay. Residents must continue to If you would like to pay for the full
pay during the semester holiday year the fees are:
break and/or if on work experience Student Village
$13,350
even if they are away from the Vil- (42 weeks)
lage. Regular instalments can be Wintec Apartments
$ 9,660
set up at weekly, fortnightly, or (48 weeks)
monthly intervals. The first instalment is due prior to or upon arrival This is based on the full year Acat the Village.
commodation Fees, Application
Fee, Contingency Deposit and AcRENT IN ADVANCE
tivity Fee.
Rent is due on Thursdays, 1 week (Please confirm half year fees with
in advance.
our staff before making payment.)