Application to Graduate March 2016
Please complete and return this application form by 19 February 2016 to Whitireia New Zealand,
Attn: Cashier, DX Box: SX33459, Porirua 5022 or email a scanned copy to [email protected]
1. Graduation ceremony
Tick here to apply to attend graduation on 17 March 2016 (diploma, degree and postgraduate programmes)
Tick here if you are unable to attend the graduation ceremony. Please fill in your details in section 2 and your qualification will be posted
to you after 17 March 2016.
2. Personal details
First name/s
Surname
Phonetic spelling (this will assist the name readers at the ceremony)
Student ID
Programme of study
Faculty
Contact details
Street address
Town/city
Telephone
Postcode
Mobile
Email address
Your name will be included in the 2016 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.
Each graduand is able to bring up to four guests. Please state
how many seats you require and any seating requirements.
Number
of guests
We may be able to accomodate additional guests if space allows. They
will be charged $20 per head. We will notify you by 3 March if they can
be accommodated.
Number of
additional
guests
4. Academic regalia
Graduands at diploma, degree and postgraduate level are required to wear academic regalia to this graduation ceremony. We
require your 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.
Please tick the type of qualification you will be graduating with and provide your measurements in the space provided.
Postgraduate
Degree
Diploma
Gown, stole, trencher, hood
Gown, trencher, hood
Gown, stole
Height in cm:
Height in cm:
Height in cm:
Head circumference in cm:
Head circumference in cm:
$50
$30
$20
If you received your degree qualification from an
institution other than Whitireia, please enter the
name of the qualification and the institution
below so that we can order the correct hood:
CONDITIONS OF HIRE
•
•
•
You are required to return academic regalia in a good condition to Te Rauparaha Arena (upstairs) after the ceremony
You will be charged for the value of any academic regalia damaged or not returned
If you are unable to attend the ceremony, we will refund you for the full cost of your academic regalia hire.
Cancellations of academic regalia must be emailed to [email protected] before 10 March 2016.
DECLARATION
I have read, accept and agree to abide by the Conditions of Hire as stated above.
Signature
Date
Day
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
Month
Year