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E n ro l m E n t I n f o r m at I o n

International Student Application
YEAR LEVEL: (PLEASE TICk ThE YEAR LEVEL whICh APPLIES) Year 9 Year 10 Year 11 Year 12 Year 13 Please attach passport photo here ] terms

START DATE: term 1 term 2 term 3 term 4 Year: 200 [ ] length of course: [

DETAILS OF STUDENT Gender: male female Date of Birth: / / last name (ason passport): first name (as on passport): Known as: Country of Birth: first language: Student Email: Student mobile number: religion:

PASSPORT/VISA DETAILS Passport number: Passport Expiry Date: Date of Entry into nZ: Student Visa/Permit Issue Date: Student Visa/Permit Expiry Date:

PARENTS DETAILS mother’s last name: mother’s first name: address: father’s last name: father’s first name:address:

Occupation: telephone number: mobile number: fax number: Email address: ( ) ) Work Phone number: (

Occupation: telephone number: mobile number: fax number: Email address:


) )

Work Phone number: (

Rangitoto College

15 October 2009

E n r O l m E n t I n f O r m at I O n

E n ro l m E n t I n f o r m at I o n

AGENTS DETAILS (Only applicable if you are usingan agent) name of agency: agent address: Contact Phone number: Contact Person: Email of agent: fax number:

NEw ZEALAND CONTACT (If applicable) name of Contact Person: address (in nZ): telephone number: mobile number: Email: fax number: relationship to you: relative (please state: family friend Parent )

GENERAL DETAILS Have you applied for rangitoto College before: If yes, when: / / Yes noYes no Have you studied at a nZ school before: Yes no

If yes, please state the school you last attended in nZ: Have you had a brother or sister enrolled at rangitoto College before: name: How many years have you studied English: Do your parents speak or read English: Speak: What is your planned future career: months Yes years no read: Yes no Year attended:

ACCOMMODATION REQUIREMENTS Do youwish to have a homestay organised by rangitoto College: I wish to organise my own accommodation (Designated Care Giver): I will be living with my parents: food Preferences (please state if any): Interests: Outdoor activities reading Other (Please state): Please provide a short letter to introduce yourself to your new host family (refer to page 7). music Water Sports movies / tV travel Yes Yes Yes nono no

(Please provide copy of your full birth certificate stating your parents names and copy of their passport and visa).

Rangitoto College

15 October 2009

E n r O l m E n t I n f O r m at I O n


E n ro l m E n t I n f o r m at I o n

DESIGNATED CARE GIVER (DCG) DETAILS (If staying in accommodation NOT organised by Rangitoto College) name of Caregiver: address (in nZ):telephone number: Email: relationship to you: relative (please state: mobile number: fax number: ) family friend name of Caregiver:

Please note: A DCG must be a relative or close family friend of the family. This accommodation must be approved by Rangitoto College prior to the student’s arrival. Please provide a copy of the passport (and visa if applicable).

INSURANCE DETAILS Do you wish topurchase insurance through Rangitoto College. We provide either Southern Cross or Unicare insurance. Both these policies we highly recommend. Please see insurance policy requirements section of the policies and procedures document. Yes no If yes: Copy: Southern Cross Yes no Insurance Expiry Date: / / or Unicare Insurance Policy Provider (if not from nZ): Insurance Policy number:

MEDICAL DETAILSany special medical or learning needs:

name of family Doctor: Phone number: ( asthma migraines allergies ) Back / neck Problems Hepatitis a or B food allergies fax number: ( Glandular fever Diabetes Epilepsy ) Bee/Wasp Stings Heart Conditions Other (please state below) Please tick the following boxes if you suffer from any of the following medical conditions:

Details of other medical...
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