English Language Programme Enrolment

Personal details:

First Name:*

Family Name:*

Preferred Name:

Nationality:*

Gender:*

Male    Female

Date of Birth:*

(day)(month)(year)

Contact details:

House/Street:*

Suburb:*

City:*

Country:*

Postcode:

Telephone:*

Email:*

Passport details:

Passport* Number:

Expiry Date:

(day) (month) (year)

Which visa will you come to New Zealand with?*    Visitor    Student    Working Holiday    Other

Course Details

Course Name/Type:*

Full-time   Part-time (am)   Part-time (pm)

Course Starting:

(day) (month) (year)

Finishing: 

(day) (month) (year)

Accommodation:

Do you need homestay accommodation?*

If Yes, how many weeks accommodation do you require?

  (We will contact you by email about this)

If no, what are the contact details of your accommodation whilst you are in New Zealand

Contact Name:

House/Street:

Suburb:

City:

Postcode:

Telephone:

Email:

Health and Travel Insurance

Further student information