International Student Application
ID:0 | 18/04/2024 |

Recipient: Guest
Originator: Guest
1 1. Application Information
1. Application Information
2 2. Home Address & Caregiver Details
2. Home Address & Caregiver Details
3 3. Agent Details
3. Agent Details
4 4. Accommodation & Insurance
4. Accommodation & Insurance
5 5. Save and Submit
5. Save and Submit
* Mandatory fields | 
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1
About Yourself

Name of the person completing this form *

Email Address: *
1
NOTE

Note: It is important that you include all relevant information about the student in your application. This information is used to ensure that the student is supported properly upon arrival and to match them with suitable homestays, teachers and courses. Where information is included relating to health issues or learning needs, disclosure of this information will not automatically disqualify the student from enrolment. However, failure to disclose information or providing misleading information may result in the withdrawal of an Offer of Place or termination of a Contract of Enrolment.
1
Student Personal Details

Legal Surname (as it appears on passport): *

First Name(s): *





Student Preferred Surname *

Preferred Name: *

Gender: *

Date of Birth: *

Country of Birth:
Country of Citizenship:
Ethnicity:
First Language:

Email Address:
Student's Phone Number (in home country):
1
Passport and Visa Information

Passport Number:
Expiry date:
Student Visa:
Expiry date:
Scan or copy of the student’s Passport title page
1
Previous schooling and study at Selwyn College

How many years have you been at school:
Most recent academic report:
Incoming Year Level:
Date of arrival in New Zealand:
Intended start date at Selwyn College:

Date of Departure:
Weeks of study:
1
Special Learning Needs

Include any specific information that we should be aware of in relation to caregiver/custody arrangements or any other information including any physical or mental condition that may affect the student's learning.
2
Students Address in home country

Number and Street
Suburb:
City:
Country:
Postcode:
2
Notes for Parents and Legal Guardians

1. It is a requirement of New Zealand regulations that schools must maintain effective communication with parents and legal guardians. To comply with the requirements, contact information provided in this section MUST be the contact information for the parents or legal guardian.

2. Names must appear as they do on your passport.
2
Parent 1 or Legal Guardian

Title:
Family Name:
First Names:
Relationship to Student:

Home Phone:
Mobile Number:
Work Phone:
Occupation:

Email:
2
Parent 2 or Legal Guardian

Title:
Family Name:
First Names:
Relationship to student:

Do you live with this student?
If not living with student - residential address: Number and Street
Suburb:
City:

Country:
Post code:
Home Phone:
Mobile Phone Number:

Occupation:
Email:
2
Emergency Contact (in home country, other than parents)

Title:
Family Name:
First name:
Relationship to student:

Mobile phone number:
Email:

3
Details of Agent or Other Person completing this form.

Title:
Family Name:
First Names:
Relationship to this student:

Phone No:
Work No:
Mobile Phone:
Email:
3
AGENCY

Name of Agency:
Street address of agency:

Please write a short introduction explaining your role and why you are completing the enrolment for this student.
4
Accommodation Requirements

International Students must be in approved accommodation during their time at Selwyn College in accordance with the Education (Pastoral Care of International Students) Code of Practice.

Choose one of the following options - then choose and complete the appropriate form below: *


If you selected HOMESTAY (arranged by Selwyn College) please download, complete and upload this form.

If you selected DESIGNATED CAREGIVER please download, complete and upload this form.

If you selected LIVING WITH PARENTS please download, complete and upload this form
4
Travel & Medical Insurance

It is a requirement of enrolment that the student has current and comprehensive travel and medical insurance.
Here is an information sheet about Southern Cross  Insurance that we can offer you. If you wish to purchase insurance through Selwyn College indicate "Southern Cross" and complete this form and upload it below.                    

If you are providing your own insurance please provide the following information: 
Name of Insurance Company and policy number:

Insurance expiry date:
Scan or save and upload a copy of insurance application form or existing policy certificate:
5
Save and Submit

Thank you for your application. Once this has been confirmed you will receive an offer of placement. 



















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