Enrolment Form

Agent (if any):
Student's Details:
Family Name:
First Names:
English Name:
Date of Birth: (Day)    (Month)    (Year)
Gender: Male    Female
Country of Birth:
Place of Birth (city):
Home Address:
Phone:
Fax:
Mobile Phone:
E-mail Address:

In an emergency, whom should we contact?
(Must be a parent for students under 18 years old).
Name:
Relationship to you:
Address:

Phone day time:
Phone night time:
Mobile Phone:
E-mail Address:
Do you have a disability or a specific learning problem? Yes    No     If yes, please list

Travel and Medical Insurance (If you are on a student visa, you must have this insurance). Do you want Excellent International Academy to arrange travel and medical insurance for you? Yes
No

English levels:
What do you think your English level is now?
(select one)		 Beginner
Elementary
Pre-Intermediate
Intermediate
Upper Intermediate
Advanced

Course: (please select)
Standard    Premier
 General English
IELTS Preparation
      (may include General English)
CIA
      (Communication In Action)

Course Dates: (Start any Monday)
When do you want to start your course?
When do you want to finish your course?
Total number of weeks applied for:

How did you find out about Excellent International Academy?
Advertisement (where)
Agent (name)
Friend (name)
Internet (which web site)
Other

Fees - In submitting this enrolment form you undertake to pay all fees as they become due and to meet any late fees and collection charges associated with debt recovery. Excellent International Academy's policy on withdrawal and refund of fees is in the Handbook, available on this website.

Trust fund - In submitting this enrolment form you agree that you authorise Excellent International Academy to arrange, where necessary, for your fees to be held in an independent trust account and for the trustee to pay your fees in arrears to Excellent International Academy. Any interest earned on the funds will accrue to Excellent International Academy.

Rules - In submitting this enrolment form you undertake to comply with Excellent International Academy's rules and policies with regard to attendance, academic progress, health and safety, and behaviour.

Notification - In submitting this enrolment form you undertake to notify Excellent International Academy of your current contact details and address at all times, and you accept that failure to do so can result in your enrolment being terminated.

Declaration - In submitting this enrolment form you declare that to the best of your knowledge all the information supplied on, and with, this enrolment form is true and complete. You also accept and agree to the terms and conditions as contained in the Handbook, available on this website. (A parent must sign for students under 20 years old).

Accommodation in New Zealand:
Do you want Excellent International Academy to arrange a homestay for you? Yes    No
If yes, please fill in the Homestay Request form below:
What do you do? Student
Work ... what is your job?
What is your highest qualification?
Major
What work do your parents do? Father

Mother
What are your hobbies and interests?
What musical instrument do you play?
What is your religion?
Most New Zealanders have a pet.
Are you allergic to animals? 		Yes    No
Do you have any special food preferences or special diet? Yes    No
If yes, please specify
Have you travelled to other countries before? (which ones?)
Have you lived away from home before? Yes    No
Are there any special items you plan to bring with you? Yes    No
If yes, please specify
Do you smoke? Yes    No
Do you mind living in a house with smokers? Yes    No
Do you have any special health or medical needs (e.g. Malaria, Asthma, Allergies)? Yes    No
If yes, please specify
Do you have any brothers or sisters? Yes    No
If yes, please give names and ages
Describe your character/personality
Is there any other comment you would like to make? Yes    No
If yes, please state
Would you like us to collect you from
the airport? 		Yes    No
When do you plan to arrive in New Zealand? Date

Flight

Time



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Excellent International Academy - English Language School - DISCOUNT prices, FREE internet, Study ENGLISH at Excellent International Academy, AUCKLAND, for the BEST ENGLISH and IELTS course and pathway to WORK and RESIDENCY in New Zealand
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