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International Student Online Application Form

1. Personal Details
Family Name First Name
Other Name Preferred Name
Male Female        Date of Birth Day Month
Year
Contact Address For Correspondence:
Home Country Address (if different from Correspondence address)
Phone Fax
Mobile Email
Are you a Permanent Resident of New Zealand? Yes   No
Passport Issued by
Passport Number 
2. Previous Study
How long have you studied English?
Years
Highest level of education
Date of Completion Month
Year
3. English Language Proficiency
Have you attended any international English test?
IELTS TOEFL OTHER
IELTS Score
Date:
Month Year
TOEFL Score
Date:
Month Year
Test Name
Score
Date:
Month Year
4. Course Details
Course Required
General English   English for Work    Office English   High School Preparation
IELTS Preparation  IELTS Foundation  Online IELTS Preparation 
OET Preparation  TOEIC Preparation 
English for Health Online Course  English Studies for Nursing Registration (ESNR) 
General English   English for Work    High School Preparation
IELTS Preparation  IELTS Foundation  Online IELTS Preparation 
OET Preparation  TOEIC Preparation 
English for Health Online Course  English Studies for Nursing Registration (ESNR) 
 Course Time
     Full Time   Morning Part Time Afternoon Part Time  Evening Part Time
     (All Courses are Minimum Enrolment of 4 weeks)
     Full Time    (Minimum Enrolment of 12 weeks)  
How long do you want to study  English?
weeks 
Date you wish to start
Day
Month
Year
5. Accommodation & Airport Pick-up
Do you want WIE to arrange your homestay?
Yes
Homestay Preference
No Children No Pets No Smoking Other
Other Preference
Is airport pick-up service required?
Yes
One Way Return
6. Insurance
International students are required to have medical/travel insurance.
 Please organise it for me
I will send proof of insurance or arrange it myself.
7. Declaration and Signature
1. I declare that the information set out in this application is correct and complete and I have not withheld any information.
2. I will observe the regulations and rules of conduct while studying at Waikato Institute of Education.
3. I have read and understood the Institute's Tuition Fees Refund and Withdrawal Policy.
4. I understand that any personal information provided to the institute and my academic performance may be made available to the New Zealand Qualifications Authority or to other government or Ministry of Education Agencies.
I agree


Waikato Institute of Education
Address: 103 London Street,
PO Box 773, Hamilton, New Zealand
Phone: 64 - 7 - 8382450   Fax: 64 - 7 - 838 2453
Email: info@wie.ac.nz