Student Services Fee Waiver Form - University of Auckland€¦ · Student Services Fee Waiver Form....
1
Student Services Fee Waiver Form AS-04 Records, Enrolments and Fee The University of Auckland Private Bag 92019 Auckland 1142, New Zealand Email: [email protected] Phone: 0800 61 62 63 Please ensure you are enrolled before submitting this form Student’s details ID number: Last name: First name Out-of-Auckland Email: address: Phone Programme Term/s and Year Student’s declaration I hereby declare that: 1. I live outside the Auckland area and have amended my address details on Student Services Online. 2. I am not using, and will not use, any of the services covered by The University of Auckland Student Services Fee, as listed below: - Accommodation Services - Chaplaincy - International Student Advisory Service - Careers Services - Disability Services - Early Childhood Education Services - Financial Advisory Service - Campus Recreation - Health Services - Student Emergency Fund - Counselling Services - Recruitment and Course Advice - Provision for the continuation of services previously supplied by AUSA (eg, advocacy services, cultural clubs, sports clubs, social activities, information services, student representation, student help centres) *By filling in this form you are submitting it in good will. If at any point you do use the facilities listed above, you will be liable for Student Services Fee. Student’s signature: Date: Student Services Fee waiver questionnaire (Please complete the following statistics for research purposes) Age ☐ Under 25 ☐ 25-30 ☐ 31-40 ☐ Over 40 Gender ☐ Male ☐ Female GP/Private health: ☐ Yes ☐ No Employment status: ☐ Full-time ☐ Part-time ☐ Not currently employed Dependants ☐ Yes ☐ No (Do you have any dependants?) Submission Please email the completed form to [email protected] Process: Processing Student Services Fees Users: Students Page 1 of 1 Last updated: 24 February 2016
Transcript of Student Services Fee Waiver Form - University of Auckland€¦ · Student Services Fee Waiver Form....
Records, Enrolments and Fees Office use only
Approved Declined
Reason:
Officer: Date:
Student Services Fee Waiver Form
AS-04 Records, Enrolments and Fee The University of Auckland Private Bag 92019 Auckland 1142, New Zealand Email: [email protected] Phone: 0800 61 62 63
Please ensure you are enrolled before submitting this form
Student’s details
ID number:
Last name: First name
Out-of-Auckland Email: address:
Phone
Programme Term/s and Year
Student’s declaration
I hereby declare that: 1. I live outside the Auckland area and have amended my address details on Student Services Online. 2. I am not using, and will not use, any of the services covered by The University of Auckland Student Services Fee, as
listed below:
- Accommodation Services - Chaplaincy - International Student Advisory Service
- Careers Services - Disability Services - Early Childhood Education Services
- Financial Advisory Service - Campus Recreation - Health Services
- Student Emergency Fund - Counselling Services - Recruitment and Course Advice
- Provision for the continuation of services previously supplied by AUSA (eg, advocacy services, cultural clubs, sports clubs, social activities, information services, student representation, student help centres)
*By filling in this form you are submitting it in good will. If at any point you do use the facilities listed above, you will be liable for Student Services Fee.
Student’s signature: Date:
Student Services Fee waiver questionnaire (Please complete the following statistics for research purposes)
Age ☐ Under 25 ☐ 25-30 ☐ 31-40 ☐ Over 40
Gender ☐
Male ☐
Female
GP/Private health: ☐
Yes ☐
No
Employment status: ☐
Full-time ☐
Part-time ☐
Not currently employed
Dependants ☐
Yes ☐
No
(Do you have any dependants?)
Submission
Please email the completed form to [email protected]
Process: Processing Student Services Fees Users: Students
Page 1 of 1 Last updated: 24 February 2016
hfar019
Typewritten Text
hfar019
Typewritten Text
hfar019
Typewritten Text
hfar019
Typewritten Text
Approved
hfar019
Typewritten Text
Declined
hfar019
Typewritten Text
Reason:
hfar019
Typewritten Text
Officer:
hfar019
Typewritten Text
Date:
hfar019
Typewritten Text
Records, Enrolment and Fees Office use only
hfar019
Typewritten Text
hfar019
Typewritten Text
hfar019
Typewritten Text
hfar019
Typewritten Text
hfar019
Typewritten Text
hfar019
Typewritten Text
