Given Name
Family Name
Student Number
Student username
Phone
Mobile
Email
Preferred form of contact Email Mail Text Message Phone Call
Age 20 or under 21-25 26-30 31-35 36-40 41-50 51+
Gender male female
Prior to studying at UC, were you At school Working At another tertiary institution Other (please specify)
Are you entering the university as University Entrance using NCEA (All Students) Admission Ad Eundem (using Overseas or International qualification) (All Students) Special Admission (All Students) Discretionary Entrance (Domestic students only) Adult Entry (Domestic students only) Postgraduate admissions (International and Domestic Students) Certificate in University Preparation (Preparatory programme, Domestic students only) Certificate in Foundation Studies (Preparatory programme, International Students only) Other (please specify)
Main course of study
Ethnicity/Citizenship
Interests
Is there any other information that will assist in matching you with a mentor? (for example, do you have a strong preference for a mentor who has similar cultural or religious background, family situation or gender - please list this below if you do)
By submitting this form, I agree to allow my contact details to be provided to the mentor I am matched with.
All information in this form will be used by the Pacific Development Team for University purposes only.