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Student Online Application Form                                                                            (* indicates required field)

1. Personal Details
Family Name*:   First Name*:
 
Middle Name: Preferred Name:
Male Female                                                     Date of Birth*: Day:   Month:  
Year:  
Contact Address for correspondence*:
Home Country Address (if different from Correspondence address):
Phone*: Email*:
 
Mobile: Confirm Email*:
 
Are you a New Zealand Permanent Resident/Citizen? Yes   No
Passport Issued by
Passport Number*
2. Previous Study
How long have you studied English?*
years
Highest level of Education Achieved*:
Date of Completion* Month:
Year:
3. English Language Proficiency
Have you sat any international English tests?
IELTS TOEFL OTHER
IELTS Score:
Date
Month Year
TOEFL Score:
Date
Month Year
Other Test:
Score
Date
Month Year
4. Course Details
Course Required*
General English   Business English OET Preparation  High School Preparation
IELTS Preparation  IELTS Foundation  Online IELTS Preparation 
TOEIC Preparation   English for Working Holiday
English for Health Online Course  English Studies for Nursing Registration (ESNR) 
General English   Business English   High School Preparation
IELTS Preparation  IELTS Foundation  Online IELTS Preparation 
OET Preparation  TOEIC Preparation 
English for Nursing English for Working Holiday (must be on working holiday visa)
 Course Time*
     Full Time   Morning part-time Afternoon part-time  Evening part-time
     (All courses are minimum enrolment of 2 weeks)
     Full Time    (Minimum enrolment of 12 weeks)  
How long do you want to study?*
  weeks 
When do you want to start (Mondays only)*
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
All International students are required to have medical/travel insurance.
 Please organise it for me
I will arrange it myself and provide proof of insurance  /  I am a domestic student
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
Level 1 Centre Place Tower, 48 Ward Street
PO Box 773, Hamilton, New Zealand
Phone: +647 838 2450   Fax: +647 838 2453
Email:
info@wie.ac.nz