Application for Cross Credit
for a Speech New Zealand Licentiate Theory Paper
Cross Crediting: Speech New Zealand will consider applications for cross crediting of optional
modules against relevant tertiary qualifications. Candidates should nominate the optional paper and
supply detailed information of the course content together with validating documents.
In giving detailed information you should ensure that each Speech New Zealand Learning Criterion for
the relevant paper is met from within your existing tertiary qualification.
(Please use a separate form for each application.)
Section One:
Family Name:
____________________________________________________________________
First Name(s):
____________________________________________________________________
Mailing Address: ____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Telephone Number:_______________________
Mobile:_______________________________
Email: ____________________________________________________________________________
Section Two:
Qualification for which Cross Credit is being applied:
Name of Diploma:
Name and number of Theory Paper you wish to apply for:
Details of Qualification you wish to credit:
1) name and number of paper/unit/course:
2) date of completion:
3) where completed:
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Section Three:
Learning Criteria
(list from relevant syllabus)
Relevant Learning
(please match to each learning criteria)
Please continue on separate sheet(s) if needed.
Section Four:
PLEASE ATTACH:
1) Verified photocopies of documentary evidence from the University or Institution that you attended.
2) If you have changed your name since obtaining the qualification, please supply evidence of the change change
of name.
3) The non-refundable application fee must be forwarded with the application form. Please refer to
the fee list on our website www.speechnz.co.nz for the applicable fee.
I enclose:
1. Scan/copy of Tertiary prescriptions
2. Scan/copy of validating document(s)
NB: If you have changed your name since obtaining the qualification, please supply evidence of the
change of name.
3. Extra information sheet(s) containing detailed information if required.
A non-refundable Cross Credit fee of $_____________ is enclosed/has been paid on line.
(Refer fee list on our website www.speechnz.co.nz for the applicable fee)
Speech New Zealand bank account number for direct credits: 02 0500 0580136 00
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