Rutherford College Community Education Centre

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Title:

First Name

Last Name

Landline

Mobile

Postal Address

Address

Suburb

City

Postcode

State

Country

Gender

Age in Years

Ethnicity

Are you a permanent resident / citizen of New Zealand / hold a Partnership Visa of a New Zealand resident or citizen?

Do you have work/working holiday visa?

Are you a Community Service/Gold Card holder?

Community/Gold card number

English language status
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Non-native English speaker

Level of achievement

Are you a migrant?

Are you a refugee?

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