Enrolment Form
Personal information
Family Name
Given Name
Address in home country
Telephone / Fax
Address in New Zealand
(if known)
Nationality
Select Your Nationality
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
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Bangladesh
Barbados
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Belgium
Belize
Benin
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Bhutan
Bolivia
Bosnia & Herzegowina
Botswana
Bouvet Island
Brazil
British Indian Ocean Terr.
Brunei Darussalam
Bulgaria
Burkina Faso
Burma
Burundi
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
China
Christmas Island
Cocos Isles
Colombia
Comoros
Congo
Congo, The Democratic Rep
Cook Islands
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Croatia
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Djibouti
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Falkland Islands
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Fiji
Finland
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French Guiana
French Polynesia
French Southern Terr.
Gabon
Gambia
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Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
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Guinea
Guinea-Bissau
Guyana
Haiti
Heard And Mc Donald Isles
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Isles
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Kitts & Nevis
Saint Lucia
Saint Vincent & Grenadines
Samoa
San Marino
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Senegal
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Sierra Leona
Singapore
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Slovenia
Solomon Islands
Somalia
South Africa
S Georgia & Sandwich Isles
Spain
Sri Lanka
St. Helena
St. Pierre & Miquelon
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Swaziland
Sweden
Switzerland
Syria
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Tajikistan
Tanzania
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Tokelau
Tonga
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Tunisia
Turkey
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Turks & Caicos Islands
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United Arab Emirates
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United States
US Minor Outlying Isles
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Viet Nam
Virgin Isles (British)
Virgin Isles (U.S.)
Wallis & Futuna Islands
Western Sahara
Yemen
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Zambia
Zimbabwe
Other
Visa
Select Your Visa Type
Tourist Visa
Student Visa
Working Holiday Visa
Other
Date of Birth
/
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Select Year
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
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1986
1987
1988
1989
1990
1991
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1993
1994
1995
1996
1997
1998
1999
Sex
Select Your Sex
Male
Female
Email
Study information
Your English level
Select Your English Level
Beginner
Elementary
Pre-Intermediate
Intermediate
Upper-Intermediate
Advanced
When would you like to start your course?
Select Start Date
4-1-2010
11-1-2010
18-1-2010
25-1-2010
1-2-2010
8-2-2010
15-2-2010
22-2-2010
1-3-2010
8-3-2010
15-3-2010
22-3-2010
29-3-2010
5-4-2010
12-4-2010
19-4-2010
26-4-2010
3-5-2010
10-5-2010
17-5-2010
24-5-2010
31-5-2010
7-6-2010
14-6-2010
21-6-2010
28-6-2010
5-7-2010
12-7-2010
19-7-2010
26-7-2010
2-8-2010
9-8-2010
16-8-2010
23-8-2010
30-8-2010
6-9-2010
13-9-2010
20-9-2010
27-9-2010
4-10-2010
11-10-2010
18-10-2010
25-10-2010
1-11-2010
8-11-2010
15-11-2010
22-11-2010
29-11-2010
6-12-2010
13-12-2010
20-12-2010
27-12-2010
3-1-2011
10-1-2011
17-1-2011
24-1-2011
31-1-2011
7-2-2011
14-2-2011
21-2-2011
28-2-2011
7-3-2011
14-3-2011
21-3-2011
28-3-2011
4-4-2011
11-4-2011
18-4-2011
25-4-2011
2-5-2011
9-5-2011
16-5-2011
23-5-2011
30-5-2011
6-6-2011
Where would you like to do your course?
Auckland
Christchurch
How many weeks would you like to study
Select how many weeks
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Course type
General English
Full time (25 hours per week)
Intensive (20 hours per week)
Part time (12.5 hours per week)
Full-time plus individual
Individual
Conversation
English Plus
50+
Teenage School
English plus Activities
Full-time English
Teacher Training
TECSOL 4 weeks
TECSOL 6 weeks (includes J-Shine)
Cambridge exams
FCE
CAE
CPE
IELTS
Accommodation
Accommodation needed?
YES
NO
Start date
/
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
/
2008
2009
2010
2011
Finish date
/
Select Month
January
February
March
April
May
June
July
August
September
October
November
December
/
2008
2009
2010
2011
Accommodation type
Homestay
Backpacker
Serviced Apartment
Hotel
Do you smoke?
YES
NO
Is it ok if other people smoke?
YES
NO
Are pets OK?
YES
NO
Do you have any allergies or other health problems?
YES
NO
If "YES", please provide details
Are there any foods you do not eat?
Any special requests?
Do you require airport pick up?
YES
NO
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