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Form for reporting convictions (Teachers)

This form is for reporting to the NZ Teachers Council if you have been convicted of an offence carrying a maximum penalty of three months imprisonment or more. You must send it within seven days of the conviction. Fields marked with an asterisk (*) are required to be entered.

Full name (*):
Maiden / Former name:
Date of Birth (*):
Current Postal Address (*):
Registration Number (*):
Email address:

Details of the offence (*)

Plea (Guilty or Not Guilty):
Name of court in which you were convicted (*):
Date of conviction:
Sentence imposed:
Do you intend to appeal against the conviction or the sentence?:

Describe the circumstances giving rise to the conviction

Enter any other information that you consider will assist
the Complaints Assessment Committee in its investigation of your conviction

If you wish to retain a printed copy of this form, select the print
function from your browser before clicking on the Submit button.
You will receive an automated email confirmation of receipt of your form if you provide a valid email address.

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