International Enrolment Form
ID:0 | 18/06/2019 |

Recipient: Guest
Originator: Guest
1 1. Application Information
1. Application Information
2 2. Caregiver Details
2. Caregiver Details
3 3. Agent Details
3. Agent Details
4 4. Learning Needs
4. Learning Needs
5 5. Accommodation & Insurance
5. Accommodation & Insurance
6 6. Student Health Record
6. Student Health Record
7 7. BYOD
8 8. Cybersafety
8. Cybersafety
9 9. The Selwyn Way
9. The Selwyn Way
10 10. Agreements
10. Agreements
11 11. Save and Submit
11. Save and Submit
* Mandatory fields | 
About Yourself

Name of the person completing this form *

Email Address: *
Student Personal Details

Legal Surname: *

Student Preferred Surname *

First Name(s): *

Preferred Name: *


Date of Birth: *

Country of Birth:

Country of Citizenship:


First Language:

Student's Address (in home country): Number and Street





Student's Phone Number (in home country):

Email Address:

How many years have you been at school:

Passport Number:

Expiry date:

Student Visa:

Expiry date:

Date of arrival in New Zealand:

Date of Departure:
Caregiver 1 Details (lives with student)


Family Name:

First Names:

Relationship to Student:

Home Phone:

Mobile Number:

Work Phone:


Caregiver 2 Details

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:

Relationship to student:

Do you live with this student?

If not living with student - residential address: Number and Street




Post code:

Home Phone:

Mobile Phone Number:


Details of Agent or Other Person completing this form.


Family Name:

First Names:

Relationship to this student:

Phone No:

Work No:

Mobile Phone:


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.
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.

Intended start date at Selwyn College:

Incoming Year Level:

How long do you intend staying at Selwn College in WEEKS?

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 - the appropriate forms will be provided: *

Travel & Medical Insurance

It is a requirement of enrolment that the student has current and comprehensive travel and medical insurance.
If you wish to purchase insurance through Selwyn College indicate "Southern Cross" and complete this form.                      

If you are providing your own insurance please provide the following information: 

Name of Insurance Company and policy number:

Insurance expiry date:

Scan a copy of insurance policy:
Student Health Record

This information is required to help us care for the student in times of illness or in emergencies. While this information is strictly confidential, it may be necessary for the safety of the student, or others, to inform relevant staff or medical personnel of medical conditions. Teachers may be informed of conditions affecting the student's education progress.

Family Doctors Name:

Doctors Phone:

Dentist name:

Dentist Ph:
Medical Conditions






Any other comments or conditions:
Medical Consents

Paracetamol consent:



Hepatitis B:





Chicken Pox:


Pneumococcal (PCV):
Considerations for BYOD: Bringing your own device

At Selwyn College, we provide a Wifi network and students are required to bring their own electronic devices from day one to support their learning.  We do not recommend a particular device because students’ needs differ. However, we do offer the following guidelines.

All our students are provided with a google apps account with 25GB of cloud-based storage to access word processing, presentations, spreadsheets, email and basic image manipulation through a browser. The performance of googleapps varies on different devices so this can be a good test to discriminate between devices.

Beyond this, the ideal device for school use

  • enables word processing, presentations, spreadsheets, image manipulation, video and audio editing
  • has some form of keyboard for typing (built-in or external)
  • is lightweight, but robust enough to handle daily use
  • has a protective carrying case
  • has 4-8 hours of battery power (or preferably more) and easy options for recharging
  • has built-in wireless capability 
  • has a common web browser (Google Chrome, Safari, Firefox)
  • is flexible, with USB ports and other options for expansion and connectivity
  • has some form of antivirus/anti-spyware protection

Suggestions for a Student Computer

If you are considering purchasing a new computer, it’s important to keep in mind what it might be used for. For example, photography students will need more processing power and storage than a computer that is used for general word processing and web browsing. However, even cheaper laptops are capable of running fairly demanding software.

While there are times when a smart phone or handheld device is an appropriate tool for a specific purpose, there are limitations that should be considered as well. One obvious problem is screen size. A small screen means it is harder to manipulate text or images than on a laptop, tablet or netbook. Lack of a physical keyboard on a handheld device makes any form of word processing much less efficient.

We do not mandate any specific models.

Cybersafety Agreement

As part of enrolment, you must agree that you have read the following rules and accept the conditions for using ICT, as well as the consequences for misuse. These rules apply to all school-related activities and any privately owned devices brought to Selwyn College or to a school-related activity.

Once you agree, a personal account will be made providing access to school facilities: computers, WiFi, email, Spider and printing. Violation of this agreement may result in the withdrawal of any or all of these facilities.

As a member of the our community you agree to the Selwyn Way which states Our electronic gear – use it appropriately

  1. Using the Internet - access is allowed with the permission and supervision of a staff member.  This applies to all internet use including access on your own device while at school or on school related activities.
  2. Use of School Equipment – equipment may be used for the purpose it was lent.
  3. Mobile Phones and other Devices – will be used in class with the express permission of the teacher for a learning activity.  Devices must not be used for inappropriate activities such as upsetting or harassing students, staff or anyone else, even as a joke. 
  4. Care and Use of ICT - you must not damage or steal any equipment or try to damage the network. You and your family may be responsible for the cost of repair or replacement of any deliberately damaged equipment.
  5. Passwords - You must keep your passwords confidential and never share them with anyone else. 
  6. Permissions - You need permission from staff to contribute material to the school website or websites used for school related activities.You must not have involvement with any unofficial website that falsely claims to represent the school
  7. Consideration of Others - You must be considerate of others by:
  • sharing equipment with others;
  • not wasting resources through unnecessary uploads or downloads;
  • not intentionally disrupting the smooth running of any school computer or network;
  • not getting involved in any use of ICT that may be offensive to others including any form of “messaging”, or the creation or display of inappropriate graphics, audio or video files;
  • getting p

Selwyn College reserves the right to check any work or data stored on or through the school’s computer network or Internet facilities.  For example, we may check your school email. If we suspect you have misused privately owned ICT at school or on school-related activities we may investigate the matter and you may be requested to allow your ICT equipment to be checked or audited. If you misuse equipment an appropriate response will be made such as: a discussion with you, informing your parent/caregiver, loss of access to school ICT, or another disciplinary action.  If ICT is used illegally, the school may inform the police.

Do you acknowledge that violation of this agreement may result in the withdrawal of access to any or all of the aforementioned facilities? 

The Selwyn Way

I agree to follow the rules and regulations of Selwyn College as they apply to all students including ‘The Selwyn Way’. I shall abide by the policies and guidelines laid down by the college for International Students living in home-stay accommodation. I further agree to obey the laws and by-laws of New Zealand.
I have read the Selwyn College Cybersafety Rules for students and accept the conditions for using ICT equipment/devices as well as the consequences for misuse for all school-related activities both at Selwyn College and away.


I understand that information relevant to their duties may be used by:    

  • Selwyn College Staff, Selwyn College Board of Trustees
  • Ministry of Social Development, Ministry of Education, NZ Qualifications Authority, Education Review Office
  • Other agencies where the information is required to maintain law and order as defined by Principal II of the Privacy Act 1988


I/We accept the right of Selwyn college to move the student from one home-stay accommodation to another host family if the College considers it is in the best interests of the student
I/We further accept the right of the College, in the best interests of the Student, to determine the appropriate level of study for the Student based on English and other assessments carried out by the college prior to starting the course of study.
I/We the parents (or guardians) authorise staff employed by the College to;
i. Receive information from any person, authority or corporate body concerning the Student including, but not limited to, medical, educational and welfare information;
ii. Provide consents in respect of any activity carried out and authorised by the school;
iii. Provide necessary consents on behalf of the Student in the event of a medical emergency where it is not reasonably practical or timely to contact the parents (or caregivers).
I/We accept that the College shall use its best endeavours to ensure the safety, health and wellbeing of the student but shall not be liable for any damage or harm caused to the Student or to the Student’s property.
I/we acknowledge that information on the Student, and her/his family, held by the College is available to me/us under provisions of the Privacy Act of 1993 and that I/we have the right to request correction of any part of this information.
I/We have read the ‘Board Refund Procedures for International Students' and we agree to the terms and conditions set out in it.
I/We have read and agree to the Terms and Conditions which govern the student’s tuition at Selwyn College.


Most recent academic report from school the student is presently enrolled at

Scan or copy of the student’s Passport title page
Save and Submit

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

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