Menu AdvocacyWelfare and Financial AssistanceDentalOptometryAdvisory GroupsClass RepsIlam ELCMontana ELCBorrow a CalculatorBorrow a bikeMenstruation EmergencyPostgrad supportInternational student supportStudy Groups Make an appointment UCSA Help - Intake Form Personal DetailsName* First Last Student ID Number*Age*Degree & Major*Year of Study - e.g. 1st Year, 2nd Year etc.*Year of Study - e.g. 1st Year, 2nd Year etc.*Student Email* Contact Phone Number*Select One* Domestic Student International Student Do you receive an NZ Aid Scholarship? Yes No How did you find out about this service?*Have you spoken to anyone else about this issue, and if so, whom?*What would you like to talk about?You must select one or moreAdvocacy Appeal Complaint / Grievance Discipline / Proctor Special Consideration Academic Progress / Exclusion Welfare Hardship Grant Mickle Fund Loan Foodbank Food Support Service UCSA Dental Yes General Enquiry / OtherIf applicable, who is the other person/party involved in this matter?What time & day would suit you best for an appointment?*PrivacyThe personal information you provide in this document is protected by the Privacy Act 1993. It will be shared with relevant UCSA staff only, unless you provide consent for UCSA staff to contact any other party. Your information will not be used for any other purpose than compiling statistics (auditing, reporting, etc).Have you read and understood the privacy statement?* Yes Contact us: Ee-Li Hong Advocacy & Welfare Manager firstname.lastname@example.org (03) 369 0450 Nathan Simkiss Student Advocate email@example.com (03) 369 0452 Jessica Andronico A&W Student Advisor | Dental Coordinator firstname.lastname@example.org (03) 369 0451 Ella Pearce A&W Student Advisor email@example.com (03) 369 0555 The UCSA office is open Monday to Thursday 8:30am till 5:00pm, and Fridays 8:30am till 4:30pm.