INTERNATIONAL STUDENT APPLICATION FOR ENROLMENT 2019
PART ONE - GENERAL INFORMATION
Tick the Form/Year Level and Term which you are applying for admission
Form/Year Form 3 (Y 9) Form 4 (Y 10) Form 5 (Y 11) Form 6 (Y 12) Form 7 (Y 13)
(Age 13-14) (Age 14-15) (Age 15-16) (Age 16-17) (Age 17-18)
Term Term 4
Term 1 Term 2 Term 3 (14/10/2019)
(23/01/2019) (29/04/2019) (22/07/2019)
STUDENT DETAILS
Family Name Mobile
Phone
First Name(s) E-mail
Nationality Ethnicity
Date of Birth Place of Birth
1st Language 2nd Language
STUDENT PASSPORT DETAILS
Surname First Name(s)
Passport No. Place of Issue
Date of Issue
Date of Expiry
CURRENT SCHOOL DETAILS
Name of School
School Address
No. of years studying English Current Year Level
PARENT DETAILS The student’s natural parent or legal guardian. This information is used for emergency purposes.
Father’s Surname Home Phone
First Name Work Phone
Address Mobile Phone
E-mail
Occupation
Name of Employer
Mother’s Surname Home Phone
First Name Work Phone
Address Mobile Phone
E-mail
Occupation Name of Employer
1
FAMILY OR FRIENDS LIVING IN NEW ZEALAND - CONTACT INFORMATION
Do you have family or friends living in New Zealand? Yes : If yes, please complete below
No
Surname Home Phone
First Name Mobile Phone
Address Work Phone
Relationship
E-mail to student
STUDENTS’ HOUSING ARRANGEMENTS
The housing arrangement for all International Students must be checked and approved by Auckland Grammar.
Please tick one of the following housing options:
I require assistance from Auckland Grammar in obtaining a homestay.
If Yes : Please Homestay Application section on page 3.
I plan to live at the following Auckland address under the supervision and care of a:
Relative* Family Friend* Agent’s Homestay Parent
Surname Home Phone
First Name Mobile Phone
Address Work Phone
E-mail
NOTE: * Parent(s) must additionally complete the Designated Caregiver Form to enable their son to live with a Relative or
close Family Friend. This form will be sent separately once the student is approved to study at Auckland Grammar. A Police Check
of designated caregivers is required for the housing pre- approval process.
2
PART TWO - HOMESTAY APPLICATION
Please complete this section if you would like Auckland Grammar to arrange a host family for you.
STUDENT DETAILS
Family Name First Name(s)
Date of Birth Preferred
Name
Nationality First Language
PERSONAL DETAILS
To help us select a suitable host family, please comment below:
What are your hobbies and interests? For example, playing an instrument, participating in sport, etc
Do you have any dietary requirements? For example: vegetarian, halal or strong dislikes?
Are you allergic to any foods, insects, medicine, or animals?
Do you suffer from asthma, migranes, skin disorders, bed-wetting, or hay-fever?
Are you on any medication?
Are there any religious observations your host family should know about?
Any special requests?
3
PART THREE - HEALTH AND INSURANCE
International Students must have appropriate medical and travel insurance while studying in New Zealand.
I would like the School to provide medical and travel insurance
I will arrange suitable medical and travel insurance before arrival**
** Students MUST provide evidence to the School of their medical and travel insurance policy before the start of
enrolment.
HEALTH STATEMENT
This information is for use by the School ONLY if the application is successful.
Note: Students should have completed the Childhood Immunisation Programme before enrolment at a NZ school.
Are you on any medication? Yes If yes, please detail: No
Please detail any current medication prescribed by a doctor.
Please tick if you suffer or have suffered from any of the following medical conditions:
Eating Disorder Anxiety None of the Above
Do you have any physical condition, learning or behavourial difficulty? Yes If yes, please detail: No
Please tick if you have any of these conditions:
Asthma Heart Condition Epilepsy
Diabetes Migraines ADD or ADHD
Allergies Depression Other: _________________________________
Need glasses / contacts Need a hearing aid
Concentration difficulty
Motor skills loss Speech impediment Other: __________________________________
PARENT’S PERSMISSION
IN THE EVENT OF AN EMERGENCY, if the School is unable to contact you, or if the illness of your son is serious and requires
immediate action, the School Nurse, a School representative, or caregiver/homestay parent may need to take your son to an
Accident and Emergency Clinic or to a hospital.
Full Name of Student
I give permission for the School/Caregiver to make any such arrangements necessary for the treatment of my son in an
emergency situation and agree to meet any costs incurred. I understand the importance to disclose any and all existing
medical and health conditions to the School, as requested above.
Parent(s) Name in Full Date
Signed by Parent(s)
4
PART FOUR - WRITING ESSAY
Please write a few paragraphs about yourself in your own hand writing.
What are your interests and achievements in sport, music or school subjects?
Why do you want to attend Auckland Grammar School?
What subjects would you like to study?
What are your career ambitions or university goals?
PART FIVE - PRIVACY OF INFORMATION
The School follows the Information Privacy Principals in the Privacy Act 1993 relating to the collection, storage, use and
disclosure of personal information.
I agree to Auckland Grammar School collecting personal information:
Full Name of Student
I have been advised by Auckland Grammar School that the information I provide will be used for:
• Student records
• Accounting purposes of the Auckland Grammar School Board of Trustees
• Communication with Alumni
• The Auckland Grammar School Old Boys’ Association
• NZ Qualifications Authority examination information
• Special Education Services
I accept that this information may later be used for statistical and/or research purposes and agree to its use for that purpose,
provided that if the information is published in any way it will not identify me or the individual concerned.
I understand that the information that I provide will be held at the offices of Auckland Grammar School at 55 Mountain Road,
Epsom, Auckland, New Zealand.
I am aware of the rights of access to and correction of this information.
We confirm that the details provided in this enrolment application and accompanying documentation are correct, true and
complete.
Signed (Student) Signed (Parent)
Student Name in Full Parent(s) Name in Full
PART SIX - HOW DID YOU FIND OUT ABOUT THIS SCHOOL?
From an Agency: Name of Agent
Name of Agency
City/Country
Email
From a friend, relative or student
From a website (specify which)
From an exhibition (specify which)
APPLICATION CHECKLIST
Please complete your application carefully. Applications which provide all the requested information will generally be
processed promptly. Missing information will inevitably lead to delays.
Applications for Admission must include:
Certified copy of your Passport, and include any current NZ visa where applicable
One recent passport-sized Photo of yourself
Certified copy of your School Report for the last two years. In the
original language and a certified English translation
Two character References
In the original language and a certified English translation
1. Headmaster and/ or class teacher
2. Family friend or relative
Additional information on English proficiency, if available
Examples: IELTS, TOEFL, AEAS
Fully completed applications and supporting documents should be sent to:
International Department
Auckland Grammar School
Private Bag 99930, Newmarket 1149
Auckland, NEW ZEALAND
E-mail: international@[Link]
DDI: +64 9 950 2183
General Information - ‘Parents’:
The word ‘parents’ on each section of the Application Form should be taken to include natural parents, guardian or
caregiver. Caregiver is a term used by the Ministry of Education to describe the person(s) taking care of the student. The
School understands that in most cases, this/these person(s) I are the parent(s) of the student.
This information is required for the Auckland Grammar School Board of Trustees Parents’ Representative Roll. Addresses given
remain confidential to the School.
Every page of the Application Form must be signed by a parent, NOT an agent, relative or any other person. It is the
responsibility of the Parent that he/she understands what is being signed.