NZQA approved category 1 provider
+64 9 379 3777

Sample Page

1: Personal Details

Family name
First name(s)
Date of Birth
Day / Month / Year
 Male Female

Passport No

Permanent Address in Home Country
Address in New Zealand
Next of kin/emergency contact name
Next of kin/emergency contact telephone number

2: Qualification/Courses

Which course do you wish to study? Please tick your choice and attach your Academic and English record, and for the ECE program two references and a New Zealand police check:
 Communication English IELTS Preparation Other English/TESOL course
 Full time (25 hrs) Full time (20 hrs) Part time (15 hrs) Part time (evening)

English Course Start Date
Day / Month / Year
Length of Course

Academic Course Start Date
Day / Month / Year
Business Programmes Timetable:
 Daytime Evening

3: Accommodation/Airport Pickup

I would like a homestay organized by AEA/ICL : Dates from to
Do you have any special requirements?  Yes No
Do you smoke?  Yes No
Do you have any allergies?  Yes No
I would like to stay at Rocklands accommodation : Dates from to
Please choose which building
 Gillies single Gillies Double Volkerling single Wiren single 1 bedroom
Do you require the School to arrange an airport pickup for you?  Yes No

4: Insurance

The NZ Ministry of Education requires travel and medical insurance for all international students. ICL and AEA provide insurance with Southern Cross's Premiums, which gives more comprehensive cover. Please see the ICL pricelist and for full details.
Do you require the following insurance protection?  YES NO
How many months? Dates from to

5: Declaration

I have read and accept the conditions of enrolment