Application form — Student services fee reconsideration

About you

First name*

Enter your first name or given name

Last name*

Enter your last name or family name

Preferred name

Massey student ID number*

Enter your ID as a number

Location of study*

Auckland campus Manawatū campus, Palmerston North Wellington campus Distance (in New Zealand) Distance (outside New Zealand)

Contact details

Email*

Enter your email address in format: yourname@example.com. We will use this to contact you about your reconsideration application.

Phone number

Where do you live when studying at Massey?

Please make sure your contact details are up to date in your student portal.

Unit, Building name

Enter the unit and/or building name if relevant, like 'Flat 1, Acme House'

Street address

Enter your street address, like '128 Valley Road East'

Suburb

RD number

Enter a Rural Delivery number if relevant

City, town or locality*

Postal code or ZIP number *

Country

Reconsideration details

To consider your application, the committee needs to know:

the reason your circumstances are exceptional
any evidence of these circumstances
what you hope to happen as a result of your application.

What semester would you like payment reconsidered for? *

Enter the semester and year you want reconsidered, like Semester 2 2022

What are your exceptional circumstances? *

Enter the reason you are applying to have your compulsory student services fee payment reconsidered. Why are your circumstances exceptional?

What evidence can you provide for these exceptional circumstances? *

Enter any evidence of your circumstances, like dates of an extended hospital stay and the name of the hospital. We will keep this information confidential

Upload any supporting documentation*

No File Chosen

File uploads may not work on some mobile devices.

Attachments must be less than 7MB in size.

Would you like to upload another file?

Yes No

Upload your second file

No File Chosen

File uploads may not work on some mobile devices.

Attachments must be less than 7MB in size.

What outcome are you seeking? *

Describe what you hope to happen as a result of your application submission. For example, 'I would like part payment of the fee reimbursed' or 'I would like to have more counselling hours made available to me'.

Declaration

Declaration of accurate information*

I agree the information I have given in this application is true and accurate

Privacy Disclosure Statement

This information is being collected to assess your application for a reconsideration of your student services fee and as strictly necessary only, to meet our other Purposes and Legitimate Interests set out in our Privacy Statement. We may be unable to process your application if you choose not to supply any information noted as mandatory. Your information will be held securely and processed in accordance with our Privacy Statement. If you would like to access or correct your information please contact us at privacy.officer@massey.ac.nz. If you are submitting this form from the European Union or United Kingdom, please also note the additional information relevant to you in our Privacy Statement.