Out of Zone Enrolment
ID:0 | 19/01/2021 |

Recipient: Guest
Originator: Guest
1 1. Application Information
1. Application Information
2 2. Immigration Status
2. Immigration Status
3 3. Caregiver Details
3. Caregiver Details
4 4. Caregiver 2
4. Caregiver 2
5 5. Emergency Contact
5. Emergency Contact
6 6. Student`s Special Learning Needs
6. Student`s Special Learning Needs
7 7. Student Health Record
7. Student Health Record
8 8. Courses
8. Courses
9 9. BYOD
9. BYOD
10 10. Cybersafety
10. Cybersafety
11 11. The Selwyn Way
11. The Selwyn Way
* Mandatory fields | 
Print
1
About Yourself

This is an application for out of zone students. If you live in our zone  please use the In Zone form instead.

Name of the person completing this form *

Email Address *

Are you in zone for Selwyn? *

Other immediate family members currently or recently enrolled at Selwyn College:

Full name of other family members (e.g. John Bloggs)
House of other family members:
1
Student Personal Details





Legal surname: *

Preferred Surname: *

First Name:
Middle Name

Name preferred to be known by:
Gender:

Students Residential Address: Number and Street
Suburb:

City:
Postcode:

Home Phone:
Student Mobile:

Student email:
Date of Birth:

Incoming Year Level:


Intended start date (choose 04/02/2021 for 2021): *

Country of Birth:

Country of Citizenship:
Either Birth Certificate Number or Passport Number:

Upload evidence (scan a copy of your NZ passport, NZ birth certificate etc)
1
Ethnicities

Please nominate up to three ethnicities

Ethnicity:

Ethnicity:

Ethnicity:
1
Iwi affiliations

Please nominate up to three affiliations here, if you need mroe please let us know during the enrolment interview

Iwi affiliation(s):

Iwi affiliation(s):

Iwi affiliation(s):
1
Student Personal Details

First Language:
Previous School in New Zealand / Overseas:

School report:
National Students Number (NSN):
2
Immigration Status

What is your citizenship status?:
Date of arrival in New Zealand:

Permit expiry date:
3
Caregiver Details

Family Name:
First Name(s):

Title:
Relationship to Student:

Home Phone:
Mobile Number:

Work Phone:
Email:

Occupation:
Name of Employer/Company:

Please tick the items that apply to Caregiver 1:
4
Caregiver 2

Enter details for a second caregiver, if residential details are the same as for caregiver one please leave these fields blank.

Family Name:
First Names:

Title:
Relationship to student:

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

Suburb:
Post code:

Home Phone:
Mobile Phone Number:

Email:
Occupation:

Name of Employer/Company:
If this caregiver does not live with the student, do you require mail concerning student welfare to be sent to both caregivers?

Please check the items that apply to Caregiver 2:
Do you wish to have fees and charges split between caregiver 1 and 2?
5
Backup Emergency Contact

Please provide details for someone who does not live with Caregiver 1 or Caregiver 2 who we can contact in the event of an emergency (when we are unable to contact Caregiver 1 or 2). In the event of an emergency at school we will contact the primary caregivers first.

Family Name:
First Name(s):

Title:
Relationship to student:

Home Phone:
Mobile Phone:
6
Student's Special Learning Needs

Please describe any special learning needs:

Comments / Sensitive Data. Please give any specific information that we should be aware of in relation to caregiver/custody arrangements or any other information that may affect this student's learning.