Enrolment Form

Student:

Agent:

PERSONAL DETAILS

Family Name:

*

Given Names:

*

Date of Birth
(dd/mm/yy):

*

Sex: *

Male Female

Nationality:

*

Address:

City:

Country:

Telephone:

Fax:

Email:

*

COURSE DETAILS

How many weeks do you wish to study for?
(min 1 week, max 48 weeks)

*

Start Date:
Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year: *

General English *

Full Time/Intensive
Part Time: Morning

What other classes are you interested in?

Exam Preparation

IELTS                                 TOEIC
Cambridge FCE and CAE     

Business English

English + Plus

  Farm Experience Internship Environmental Volunteer Programme International Flight attendant Scuba Sailing Surfing Travel and Tourism Au Pair Working Holiday Visa

ACCOMMODATION DETAILS *

I will find my own accommodation
I wish to stay with a host family
I wish to stay at the school apartments (note for Combo enrolment: Napier has no student apartments)

Accommodation required:

From:
Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year:

To:
Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month: 1 2 3 4 5 6 7 8 9 10 11 12 Year:

For: Weeks

What kind of Homestay do you want? We will do our best to meet your requests.

Family with children
Family with no children

Do you smoke?

Yes No

Can you eat most foods?

Yes No

Please tell us foods you CANNOT eat...

Do you have any health problems or allergies?

Yes No

If YES, what are they?

MEDICAL INSURANCE *

Do you want us to arrange medical insurance for your stay in NZ?
Medical Insurance is required. Information about Insurance in New Zealand can be found on the website. http://www.uni-care.org

Yes, please arrange for me and add to invoice.
No, I will arrange myself and send proof.