Application to Graduate March 2015

Application to Graduate March 2015
Please complete and return this application form by 16 February 2015 to Whitireia New Zealand,
Attn: Cashier, DX Box: SX33459, Porirua 5022 or email an electronic copy to [email protected]
1. Graduation ceremony
I am applying to attend graduation on 19 March 2015 (diploma, degree and postgraduate programmes)
Tick here if you are unable to attend a graduation ceremony. Your award will be posted to the address listed below after being conferred
on 19 March 2015.
2. Applicant's details
Student ID
Surname
First name/s
Phonetic spelling (this will assist the name readers at the ceremony)
Programme of study
Faculty
Contact details
Street Address
Town/City
Telephone
Postcode
Mobile
Email address
Tick here if you would like to keep in touch with Whitireia in the future (Whitireia Alumni).
Your name will be included in the 2015 Graduation handbook and could be listed with other graduates in the Dominion Post.
Please contact us if you DO NOT wish your name to be included.
3. Seating requirements
GRADUAND SEATING
GUEST SEATING
Graduands attending the ceremony will be allocated a seat
alphabetically by programme. Please advise if you have any
special seating requirements.
Due to the size of our venue, we ask that you bring four guests.
However, we will attempt to accommodate all requests. Please
state how many seats you require and any seating requirements.
Number
of guests
Signature
Date
Day
Month
Year
Please complete page two of this form
4. Academic dress
Graduands at diploma, degree and postgraduate level are required to wear academic dress to their graduation ceremony. We
require your full height so we can order the correct gown size. If you are degree or postgraduate qualified, we also require your
head circumference for the trencher. A height chart and tape measure are available at the cashier’s office in Information and
Enrolment at our Porirua campus.
WHAT YOU NEED TO WEAR
Diploma:
Degree:
Postgraduate:
gown, stole
gown, trencher, hood
gown, stole, trencher, hood*
*Hood is optional. Trencher is only required if you are already degree qualified. If you gained your degree from another institution, it is your responsibility to
order the appropriate hood if desired.
ORDER
Tick
Gown
Whitireia Hood
Whitireia Stole
Postgraduate Stole
Trencher
Measurement
Full height in cm:
N/A
N/A
N/A
Head circumference in cm:
Hire cost
$30
$10
$10
$10
$20
Total payable
Amount payable
CONDITIONS OF HIRE
•
•
•
You are required to return academic dress in a good condition to Te Rauparaha Arena (upstairs) after the ceremony
You will be charged for the value of any academic dress damaged or not returned, and you will also be liable for debt
collection costs
The cost of academic dress hire is not refundable from two weeks prior to the ceremony
DECLARATION
I have read, accept and agree to abide by the Conditions of Hire as stated above.
Signature
Date
Day
Month
Year
PAYMENT DETAILS
Cheque
Please make cheque payable to Whitireia Community Polytechnic
Credit card
Credit card number
Expiry date
Month
Cardholder's name
Direct credit
Amount
Year
$
Cardholder’s signature
Date of direct credit
Please make payment to the following account and include the details in the box as reference
Account Name: Whitireia Community Polytechnic
Account Number: 12-3244-0004001-00
Particulars
GRAD MARCH
Code
[Student ID]
Reference
213071500
Please return your completed application form to the cashier’s office in the Information & Enrolment Centre at the Porirua
campus. Alternatively, you can post it to Whitireia New Zealand, Attn: Cashier, DX Box: SX33459, Porirua 5022 or email an
electronic copy to [email protected]
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