APPLICATION for Enrolment

I WISH TO APPLY FOR ENTRY TO THE COURSE COMMENCING:

Year 1         February       April          July    Year  

Year 2         February       April          July    Year  

Year 3         February       April          July    Year  


PERSONAL DETAILS

Surname:

Address:

Address:

Address:

First name:

Date of Birth:

Home Phone:

Work Phone:


EDUCATIONAL BACKGROUND

Secondary School:

Sixth Form Certificate Subject:




Other:




 

Grade










 

Year











EMPLOYMET BACKGROUND

EmployerPosition Held

Dates Employed Reason for leaving


Employer
Position Held

Dates Employed Reason for leaving


Employer
Position Held

Dates Employed Reason for leaving


Employer
Position Held

Dates Employed Reason for leaving


Employer
Position Held

Dates Employed Reason for leaving

 
REFEREES

Name:

Address:

Phone Number:

Name:

Address:

Phone Number:


MEDICAL HISTORY

Asthma
Epilepsy
Diabetes		 Hearing disability
Sight disability
Psychiatric disorders		Other ( please state )

SUITABILITY FOR REGISTRATION 
AS A TEACHER / EDUCATOR

The New Zealand College of Early Childhood Education is responsible, on behalf of the New Zealand Qualifications Authority, to select applicants for training who are deemed to be of "good character". The College must also ensure that successful applicants are "fit to be a teacher". This is assessed during training. To obtain registration as a teacher: "Sexual or violet offences involving young people would disqualify a person for registration, as would drug offences. Character references are to submitted for registration". ( Extract from the Registration of Teachers in New Zealand  ( Teacher Registration Board, 2nd Ed, Feb 1991, Appendix 11, p 42)



CHECKLIST

I AM SENDING CERTIFIED COPIES OF THE FOLLOWING DOCUMENTS WHICH APPLY TO ME:

Passport size photograph
Birth Certificate
School qualifications

I am sending ( enclosed )  the following:
Three character references ( in addition to the referees above )
Registration fee of $56.25 ( non - refundable )
Any other relevant papers 

DECLARATION

I declare that the above details are correct. I undertake to adhere to the requirements of the New Zealand College of Early Childhood Education and to be responsible for the payment of fees as they fall due.

Full Name  &  Signature 

When Completed send to: 
NZCECE
P.O. Box 25-225
CHRISTCHURCH