Trainee Universal Application Form This form is to be used by IPLS trainees who wish to withdraw from the course, transfer to an alternative intake, defer an assessment, complete a seminar and assessment in a subsequent intake, complete new assessment/s or appeal a grade. It must be read in conjunction with the Application Policy and Procedures document in your Trainee Handbook. Trainee Name*Please enter your full namePreferred name*Your First name or the name you are usually known asYour email address* Enter Email Confirm Email InstructorPlease enter your instructor's nameI am currently enrolled in the following centre*AucklandHamiltonWellingtonChristchurchDunedinI am enrolled in intake/seminar*Please enter your intake or seminarI apply to*Sit further assessment/sDefer an assessment (reason and evidence required)Transfer to an alternative intakeWithdraw from the course (reason required)Repeat the entire course (reason required)Appeal my grade (see box below)Seminar/s*Please enter which seminar/s you wish to sit a further assessmentIntake to which I wish to transfer*My reason for this application*Please give your reason for this requestI apply to appeal my grade under regulation:*Regulation 19(2)(a)Regulation 19(2)(b)Regulation 19(2)(c)Regulation 19(2)(d)Regulation 19(2)(e)Regulation 19(2)(f)Terms In submitting this form electronically I have agreed to the provisions stated on this page and understand that I will be invoiced in accordance with the published fee schedule. Fees Payable Information on other fees can be found here. You undertake to pay all fees as they become due and to meet any late fees and collection charges associated with debt recovery. Credit card surcharges apply to all payments made by credit card (2.35% for course fees and assessment fees and 2.85% for transfer and appeal fees). Declaration I declare that to the best of my knowledge all the information supplied on, and with, this form is true and complete. I consent to the disclosure of personal information and I undertake to pay fees and comply with the IPLS regulations and policies as described above. This Application Form covers Regulations 4(4), 4(7), 12, 13, 16, 17, 18, 19, 21Agreement*I agree to the conditions aboveI do not agree to the conditions aboveSupporting Documents NOTE: Supporting documents should be emailed separately to tuaform@ipls.org.nz as soon as possible