Emerging Leadership - Reporoa

Enrolment Application for Emerging Leadership course – Reporoa
This course includes a two-hour introduction online session on 23/09 online, and four in-person workshops held in between milkings on 30/09, 14/10, 04/11, 25/11.
Identification
Your email address*
Preferred title (please circle)
- Ms
- Miss
- Mrs
- Mr
- Master
- Dr
Legal name(s)*
Please ensure your legal name is consistent with your passport or citizenship / permanent resident / work visa
First Last
Do you prefer to go by a name different to your legal name?
- Yes
- No
Preferred name(s)*
First Last
Have you previously been known by a different name?*
- Yes
- No
Previous name(s)*
First Last

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Course requirements (designated workplace supervisor)
Enrolling in the Emerging Leadership course requires learners to provide a name and email address for a designated workplace supervisor (on-job senior, manager, owner) who is willing to provide learning supervision and observation of on-job assessment tasks. If you would like to discuss this with them before completing your enrolment form, please select the ‘save and continue later’ option at the bottom of this form.
Designated workplace supervisor contact details
When this enrolment application is submitted, an automated email is sent to your designated workplace supervisor advising them that you have enrolled in this leadership course in which you are required to complete work-based assessment tasks and have task completion verified by them. Dairy Training’s contact information will be provided to enable your supervisor to contact the Dairy Training office with any questions or concerns.
Designated workplace supervisor names*
First Last
Designated workplace supervisor email*
Enter Email Confirm Email
Designated workplace supervisor phone number*
Relationship to you*
i.e. manager, farm owner or on-job senior.
Does your designated workplace supervisor know you have selected them as part of this course?*
- Yes
- No

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Returning student information
Have you previously attended any of the following courses?*
- Progression Management
- Business by the Numbers
- Write a Business Plan
- Contract Milking
- Farm Enviromental Planning
- Other
- None of the above

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Identification continued
Date of birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Other
National student number*
Please write ‘unknown’ if unsure
Are you likely to have a National Student Number (NSN) registered in another name?
- Yes
- No
What is the other name?
First Last
What is the other National Student Number (NSN)?*
Please write ‘unknown’ if unsure
Please attach a copy of your verified marriage licence to conform this other name.
If you don’t have this document, please continue with your application and we will follow up with you on this prior to offering you a place in the programme.
Max. file size: 100 MB.

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Personal details
What is your citizenship or residency status?*
You will need to provide evidence of citizenship, residency, permanent residency or work visa status.
- New Zealand citizen
- New Zealand permanent resident
- Australian citizen
- Australian permanent resident
- New Zealand work or residency visa
What ethnic groups do you belong to?*
You may select up to three
- Māori
- New Zealand European
- African
- Australian
- British and Irish
- Cambodian
- Chinese
- Cook Island Māori
- Dutch
- Fijian
- Filipino
- German
- Greek
- Indian
- Italian
- Japanese
- Korean
- Latin American
- Middle Eastern
- Niue
- Polish
- Samoan
- South Slav
- Sri Lankan
- Tongan
- Tokelauen
- Vietnamese

What is the name of your Iwi?

You may provide more than one Iwi.

Iwi 1	Iwi 2	Iwi 3

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Education history continued
What is the name of the first tertiary organisation you studied with?
What was the first year of your enrolment with the above organisation?
Please list the highest tertiary qualification you hold
Are you currently enrolled in any other study?
- Yes
- No
Please specify what other study you're currently enrolled in:

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Contact details
Your location*
Your home address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Is your postal address different from your home address?*
- Yes
- No
Your postal address (if different from home address)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*

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Emergency contact details
Emergency contact details:*
First and last name Relationship to you Emergency contact phone number

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Verification
In-person courses – You must either upload a verified* copy of one of the documents below or an unverified copy of the document and bring the original on Day 1 of your course to be sighted by your tutor.

Online courses – You must upload a verified* copy of one of the documents below.
Attach a document
Select one of the options and attach the following documents*
Tip: Simply take a photo of the document with your smartphone and upload it.
- A verified copy of a birth certificate with place of birth stated as New Zealand, Australia, Cook Islands, Tokelau, or Niue
- A verified copy of a New Zealand or Australian passport (a current or expired passport is acceptable, but not not a cancelled passport)
- A verified copy of a statement of Whakapapa, including date of birth, counter signed by Kaumatua (if no birth certificate or passport exist)
- A verified copy of a passport AND a certificate of citizenship or letter of confirmation
- A verified copy of an overseas passport AND a verified copy of a work or residency visa
A verified copy of an overseas passport*
This is required because you have indicated you are a student on a work or residency visa.
Max. file size: 100 MB.
Attach a verified copy of a work or residency visa*
This is required because you have indicated you are a student on a work or residency visa.
Max. file size: 100 MB.
Attach a certificate of citizenship or letter of confirmation*
This is required because you have indicated you are a student on a work or residency visa.
Max. file size: 100 MB.
A verified copy of a birth certificate with place of birth stated as New Zealand, Australia, Cook Islands, Tokelau, or Niue*
Max. file size: 10 MB.
A verified copy of a New Zealand or Australian passport*
Max. file size: 10 MB.
A verified copy of a statement of Whakapapa, including date of birth, counter signed by Kaumatua (if no birth certificate or passport exist)*
Max. file size: 10 MB.
A verified copy of a certificate of citizenship or letter of confirmation OR*
Max. file size: 10 MB.
A verified copy of an overseas passport with residency stamp*
Max. file size: 10 MB.
Additional documents (optional)
If you have any additional documents to upload, please upload them here.
Max. file size: 10 MB.
Additional documents (optional)
If you have any additional documents to upload, please upload them here.
Max. file size: 10 MB.
* A verified document is a copy of the original document which has been signed and dated by someone who can confirm that it's the same as the original. Verification can be done by a Justice of the Peace, Barrister, Court of Deputy Registrar, Member of Parliament, Land Transport NZ, or Public Trust

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Consent
You must tick all four ‘I agree’ boxes on this page to move to the next page of this enrolment form.
A. Eligibility – course entry requirements*
Entry into the [course] will be in accordance with the Dairy Training Course Entry Policy and Procedures, and as outlined below.

Learners must:
1. Be 18 years of age or older
2. Have evidence of appropriate language competency if English is not the applicant’s first language such as IELTS of average 5.5 with no band under 5
3. Have previously completed at least two years of agriculture workplace experience within the past five years
4. Have proficiency in English and Mathematics that will enable likely successful completion of this course (for example a minimum of NCEA English and Maths level 1, or equivalent)
5. Have access to relevant farm records and information and if required have employer support to complete on-farm tasks
6. Have their application reviewed by Dairy Training staff.

Applications outside the above conditions of entry may be considered in some circumstances, at the discretion of the Dairy Training Manager.
I agree to the Eligibility requirements
B. Fees (if any)*
By completing 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. Student fees are held in a holding account for safeguarding.

Note there are no course fees for Dairy Training courses.
I agree to the Fee (if any) requirements
C. Privacy – supply of information to government agencies and other organisations*
Dairy Training collects and stores information from this form and may share it with government agencies, including:
• the Ministry of Education
• the New Zealand Qualifications Authority
• the Tertiary Education Commission
• the Ministry of Social Development
• Immigration New Zealand

Those agencies use the data supplied by tertiary education organisations to:
• administer the tertiary system, including allocating funding
• develop policy advice for government
• conduct statistical analysis and research

The Ministry of Education may supply data collected on this form to Statistics New Zealand for the purposes of integrating data with data collected by other government agencies, subject to the provisions of the Statistics Act 1975. Integrated data is used for the production of official statistics, to inform policy advice to government and for research purposes.

When required by law, Dairy Training releases information to government agencies such as the New Zealand Police, Department of Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC).

Information collected on this form may be supplied to other educational organisations for the purpose of verifying academic records.

Dairy Training may share your basic details and course attendance information with our parent company, DairyNZ, as evidence of engagement and to enable contact regarding further extension and/or training opportunities.

In signing this application form you authorise such disclosure on the understanding that Dairy Training will observe the conditions concerning the release of information, as set out in the Privacy Act 1993, the Education Act 1989 and other relevant legislation.

You consent to your email address being used to send academic material and information associated with the programme. You may request to see any information held about you and request that any errors in that information be amended or noted. To do so, contact admin@dairytraining.co.nz

Learners can access Dairy Training’s full privacy statement by visiting our Privacy Policy webpage at https://dairytraining.co.nz/privacy-policy/
I agree to the Privacy requirements
D. Withdrawal*
Dairy Training understands that student circumstances can unexpectedly change. If you enrol and then think you won’t be able to attend, make sure you talk to a Dairy Training staff member as soon as you can to see if we can help in any way and to try and avoid any financial penalties. Following are important rules around fees to be aware of:
1. Students considering withdrawing need to notify the tutor or Dairy Training and discuss the reasons and implications with their tutor, preferably prior to the commencement of the first class.
2. Students withdrawing prior to the commencement of the programme will be entitled to a full refund minus the administration fee.
3. Students withdrawing within the 10% period will be entitled to a refund of the fees paid minus the administration fee.
4. Students withdrawing after the 10% period will not be entitled to any refunds
I agree to the Withdrawal requirements

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Declaration
Please read this declaration carefully before you submit. It is an offence under the Crimes Act 1961 to make a false declaration.

• I declare that to the best of my knowledge all the information supplied on and with, this application for application form is true and correct.

• I agree to abide by the conditions described within this document and consent to the disclosure of personal information as described above.

• I acknowledge that my enrolment is not complete until I have provided all relevant personal information, established my identity, and paid all relevant fees (if any) and charges in accordance with the Dairy Training terms and conditions of enrolment.
Enter your first name and surname*
This indicates you have read and agree to the above declaration.
Today's date*
To confirm declaration
MM slash DD slash YYYY

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Emerging Leadership – Reporoa

Enrolment Application for Emerging Leadership – Reporoa

Step 1 of 14

Enrolment Application for Emerging Leadership course – Reporoa

Identification

Course requirements (designated workplace supervisor)

Designated workplace supervisor contact details

Returning student information

Identification continued

Course knowledge

Personal details

Occupation and needs

Education history

Education history continued

Contact details

Emergency contact details

Verification

Attach a document

Consent

Declaration