EmailMe Form - APPLICATION FORM PART 1

Note: It is important that you include all relevant information about the student in your application. This information is used to ensure that the student is supported properly upon arrival and to match them with suitable homestays, teachers and courses. Where information is included relating to health issues or learning needs, disclosure of this information will not automatically disqualify the Student from Enrolment. However, failure to disclose information or providing misleading information may result in the withdrawal of an Offer of Place or termination of a Contract of Enrolment. Please type in the boxes in English.

STUDENT DETAILS

(Name must be as it appears on your passport)

Family name: *

First name: *

Preferred name: *

*

Male

Female

Date of birth *

DD / MM / YY

Email address: *

Address: (In home country) *

First language: *

Country of citizenship: *

Passport number: *

Expiry date of passport: *

MM / DD / YYYY

Intended START date: *

DD / MM / YY

Intended END date: *

DD / MM / YY

Applying for year level: *

PARENT ONE OR LEGAL GUARDIAN:

(Name must be as it appears on your passport)

NOTE: It is requirement of New Zealand regulations that schools must maintain effective communication with parents and legal guardians. To comply with the requirements, contact information provided in this section MUST be the contact information for the parents or legal guardian.

Title: *

Family name: *

First name: *

Date of birth: *

DD / MM / YY

Street address: *

Postal address: *

Home phone: *

Mobile phone: *

Email *

First language: *

Country of citizenship: *

Passport number: *

Expiry date of passport:

DD / MM / YY

PARENT TWO OR LEGAL GUARDIAN:

(Name must be as it appears on your passport)

NOTE: It is requirement of New Zealand regulations that schools must maintain effective communication with parents and legal guardians. To comply with the requirements, contact information provided in this section MUST be the contact information for the parents or legal guardian.

Title: *

Family name: *

Date of birth: *

DD / MM / YY

First name: *

Street address: *

Postal address: *

Home phone: *

Mobile phone: *

Email *

First language: *

Country of citizenship: *

Passport number: *

Expiry date of passport: *

DD / MM / YY

Initialled by PARENT

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Initialled by STUDENT

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