Part 1: Personal details |. What ie your client number? fyouhavereceivedassstance from Study.inkor Workandincome before, write your cient number hereifyouknowt. This number canbe foundon your Community Sarices Cadi youhaveone. GQU8IGGA1820 2. _Whatie your fullname? GARETH MOAN. AAT, |3, Whats your legal namo asit appears on your birth cartfiate? (if itferent fromabove) 4. What date ware youborn? GTS oy (O]A) monn (Ula TOTS vow Qeneedtoseea verted copy of your birth crtficate or passport (unas Study.ink has already seen) 5. Where will youlive while studying? If youdon'tinow where you willbe ving goto Question 6 bux youneedtoletusinow as sconasyoudo. Pleasernote this mustbes New Zeslrdaderess anda the adres of your education provide. Massey OMVERETTY gSISP™T excroRoFscimce |ancoi2n |aLmaNy | NO [ovon/ais |inozoi6 | Sit ed Gt [20/600 [inv Ws 121 13| 31618 Proyert Mag | 2397 [vr [ar o J rt [tt 7. Willyoube completinga recognised programme of study that youhave previously studiad (but did not complete)? Yournystbe studyingmore than half of afulstime cous, Yes(Goto Students declaration onpage 4) (__] no(Gotoas a a Limited Full-time Status application form Page __ __ _Part 2: Statement from authorised staff member “This section must be completed by an authorised staff member from your education provider Fyoutteunsure who needs to complete this section, askat your education provi, Authorised tat members eats Firstname | Midalenamecs) | Sumame or familyname Wareen Smt, Potion ‘Daytime phone number gwen oye 3 211 21099 ext SB'! Private Bag 90114 Invercargill Phone 0800 748 257 03 211 2699 Ext 3320 | Surname or famityname ] Themes J have previously stud (buted nat complete) and to dothis easly xplinthe reason why youthink his student shoul not toy fl time: “These are the lash vse _pagecs tne. Shader peed s “ts _comelete far AWS pragramme. ta amber signature ) = —_— ‘jee (O[2) move (Qo [J] re | Limited Full-time Status application form PageS.- >) (2)Documents to provide Acooensert Stuiokmustbea erfedcop Avid copy nacepyol eal ocumert which hasbeen sien ated by someone Sct ane. Notary ut Cout Reg, approved pren ata edscston rol sod pea Stlinkor Work and income staf member or Justice ofthe Peace stein te Yellow Pages) who.can confrmthatthecopyis the smeasthe orga They must printthar name ante on each page and write tatitis atrue copy and int Thebest ay send yu docurertso usin ur we comet cosa. Pease erent nical yourrameandtent utr vthary ocuentthalyousenious Farmer farratonit ww comeckeome Youneedtopovieanyromatonwe nedbelre te nc ou course oryour Student Aowanceapletnaybe decir Mtyefinshngarecossed programme at youhave previo studied ou dd not complete) andtod tis yoare sting less thon fle but mre thon alo fl-ime ours hearse stall maber om your eatin prover peat confman page that you suyillconpe record (Wircgune With support from your education provider ‘An authorised staf member from your education prov programme, [Ly ovate iter nae ast youneedo provide alter toma maa rfl coreg ya cncon wre You J studyingful-time anditthe coreition isnot permanent howlogitis tikelyto continue wed to confimon page’ that your study wilcompletearecognised Ithereis some otner reason for sufficient cause outside your contol you wialsoneedto provide letter or statement froma professional (ikea counsellor) confirming you cant study ful-time and exlaning the reasons wy, Student’s declaration The information have provided is true aeithave not left anything out. |understancthatf have madea falsestatement ox dor tll StudyLinkofachangeinmy creumstances that my Stucent Alowanceor Student Loanpayments may top thishoppens lunderstandthat wihaveto payback any overpayments pis calection costs and couktbe prosecuted erie: signature [_ SD (BLT) moun (ZIP I) vear Page 4 Limited Full-time Status application form