Student Details (Name must be as it appears on your passport)
Family name
First name
Date of birth
Preferred name
Address (Home Country)
Address (New Zealand)
First language
Country of citizenship
Passport number
Expiry date
Intended start date
Intended end date
NZ / NHI Number
Parent One or Legal Guardian: (Name must be as it appears on your passport)
NOTE: It is a requirement of New Zealand regulations that schools must maintain effective communication with parents and legal
guardians. To comply with the requirements, the contact information provided in this section MUST be the contact information for the parents or legal guardians.
Family name
First name
Occupation
Relationship to Student
Date of Birth
Address (If different from above)
Mobile
Email
First language
Country of citizenship
Passport number
Expiry date
Parent Two or Legal Guardian: (Name must be as it appears on your passport)
NOTE: It is a requirement of New Zealand regulations that schools must maintain effective communication with parents and legal
guardians. To comply with the requirements, the contact information provided in this section MUST be the contact information for the parents or legal guardians.
Family name
Date of Birth
First name
Occupation
Relationship to Student
Address (If different from above)
Mobile
Email
First language
Country of citizenship
Passport number
Expiry date
Emergency Contact (other than parents):
Contact's name
Relationship to the student
Mobile phone
Email address
Agent Information (If using an agent)
Agency name
Agent name
Agent email address
Agent phone
Medical Information
Other
Please tick which applies:
If ‘No’ please specify what medication you do not want the student to receive:
Learning Information- please provide a copy of the latest two school reports with the application (Must be translated into English)
Current school:
Grade/Year level:
If the student does not currently attend school, please give reason and date of last attendance:
Please describe your learning goals for studying in a New Zealand school (attach more pages if required).
How many years of schooling not including pre-school education has the student had?
If Yes, please give details (dates and reason):
Please provide a copy of the lastest two school reports for the student with this application.
If ‘Yes’, please provide details (attach more pages if required).
General Details
If yes, when?
Name
Year Attended
If yes, please state the name of the school:
How many years has the student studied English?
If ‘Yes’, please provide details
attach more pages if required
Accommodation Requirements
Insurance Details
As per Code 16D insurance is compulsory for international Students coming to New Zealand.
Insurance Company
Policy Number
Insurance cover start date
Insurance cover start date
Please provide an English copy of the policy details with this application form
Further Documents
Photograph of the student
A hand-written letter from the student, if possible, introducing themselves, and explaining their reasons for wanting to study at the school
A copy of the student’s passport including passport number and expiry date
A copy of the student’s vaccination certificate
Consent
I confirm I have read and understood the code of Conduct, Investigation policy and refund policy
I agree to the Terms & Conditions
Key Terms:
If other, pleace specify
Caregiver 1 Name
Student's Name
Submit
