International Student Enrolment Form

"*" indicates required fields

Part One: Personal Information

Student Name*

First Last

Date of Birth*

Age in Years*

Gender*

Male

Female

Student's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Student's Mobile*

Student's Personal Email*

First Language*

Years Studying English*

Religion / Belief

Do you need to attend church or another place of worship on a regular basis?

Yes

If Yes, state which church*

How do you hear about Cullinane College?*

Passport / Visa Details

Passport Number*

Passport Expiry Date*

Student Visa Issue Date

Student Visa Expiry Date

When do you expect to arrive at Cullinane College?*

Parent’s Details

Mother's Name*

First Last

Mother's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mother's Occupation*

Mother's Home Phone

Mother's Work Phone

Mother's Mobile*

Mother's Email*

Father's Name*

First Last

Father's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Occupation*

Father's Home Phone

Father's Work Phone

Father's Mobile*

Father's Email*

Emergency Contact Details

Emergency Contact Name*

First Last

Relationship to Student*

Emergency Contact Phone

Emergency Contact Mobile*

Emergency Contact Email*

Emergency Contact Country*

Agent Details

Company*

Agent's Name*

First Last

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Agent's Phone*

Fax Number

Agent's Email*

Contact should be through:*

Agent

Parent

Part Two: Living Situation in Your Home Country

What type of home do you live in, e.g. apartment, house, etc.?*

Where is your home located, e.g. city, town, countryside etc.?*

How do you get to school, e.g. walk, bus, train etc.?*

Who usually looks after you?*

Do you have any brothers or sisters?*

Yes

How many brothers or sisters do you have?*

Sibling One Name*

First Last

Sibling One Age*

Sibling One Gender*

Yes

Does this sibling live at home?*

Yes

Sibling Two Name*

First Last

Sibling Two Age*

Sibling Two Gender*

Yes

Does this sibling live at home?*

Yes

Sibling Three Name*

First Last

Sibling Three Age*

Sibling Three Gender*

Yes

Does this sibling live at home?*

Yes

Sibling Four Name*

First Last

Sibling Four Age*

Sibling Four Gender*

Yes

Does this sibling live at home?*

Yes

Sibling Five Name*

First Last

Sibling Five Age*

Sibling Five Gender*

Yes

Does this sibling live at home?*

Yes

Not counting yourself or any brothers and sisters, how many other people live in your home?*

Who else lives in your home? (Mother, Father, Uncles, Aunts, Grandparents, etc)

Lives at Home One*

First Last

Relationship to Student*

Lives at Home Two*

First Last

Relationship to Student*

Lives at Home Three*

First Last

Relationship to Student*

Lives at Home Four*

First Last

Relationship to Student*

Lives at Home Five*

First Last

Relationship to Student*

Part Three: Hobbies, Interests and Sports

What sports do you play? Please list your level of experience next to each sport, e.g. social player, school team, regional representative etc.

Sport One

Level of Experience

Sport Two

Level of Experience

Singing and Musical Instruments

Do you sing?*

Yes

How many years have you been singing?*

Are you in a band or a choir?*

Yes

What is the name of your band or choir?

Do you play any musical instruments?*

Yes

Instrument Played*

Level of Experience*

Instrument Played

Level of Experience

What are your hobbies or interests, e.g. model trains, collecting stamps etc.?*

Are there any other sports or hobbies that you would like to be involved in while you are in New Zealand?

Do you have any other particular talents, dislikes or problems?

Part Four: Health Information (Parents to Complete)

Does your child have any pre-existing medical conditions or concerns?*

Yes

Please state:*

Does your child have any allergies, e.g. food allergies like peanuts or wheat, or medical allergies like penicillin or bee stings?*

Yes

Does your child carry any medication for this allergy?*

Yes

Name any medication your child requires*

Are there any family medical conditions that we should know about to ensure the safety of your child, e.g. food allergies, bee sting allergies?*

Yes

Please state*

Does your child have any other special health or medical needs?*

Yes

Please state*

Does your child have any psychological / emotional needs?*

Yes

Please state*

New Zealand children are vaccinated against the following diseases. Please select the ones your child has been vaccinated against:*

Diphtheria

Hepatitis B

Measles

Mumps

Polio

Rubella (German Measles)

Tetanus

Tuberculosis

Whooping Cough

Has your child had, or suffer from, any of the following illnesses?*

Part Five: Study Information (Parents to Complete)

Does your child have any specific learning needs or difficulties that could affect their progress?*

Yes

Please state*

Does your child have any behaviour issues?*

Yes

Please state*

What is your estimate of your child’s level of English?*

Beginner

Elementary

Pre-Intermediate

Intermediate

Upper Intermediate

Would you like a personal English Tutor at a cost of $50 NZD per hour?*

Yes

Part Six: Study Information

What are your favourite subjects at school?*

What do you find the most challenging about school?*

What do you enjoy most about school?*

What are your dreams and ambitions?*

What are you hoping for or looking forward to in your New Zealand School?*

What worries you have about living and studying in New Zealand?*

Part Seven: Other Information

Have you travelled to other countries before?*

Yes

Which countries?*

Have you lived away from your family before?*

Yes

Please describe*

Do you plan to return home in the term holidays?*

Yes

Is there a particular part of your culture that is very important to you that we should know about?*

Are there are special items you plan to bring with you?*

What is your favourite food?*

Is there any particular food that you cannot eat or do you have any special dietary requirements, e.g. vegetarian, don’t eat chicken or pork etc.?*

Is there any particular New Zealand food that you are looking forward to eating?*

Part Eight: Information to Help the School Place You in Classes

Parent / Agent:
The student needs to complete an essay. Please encourage but do not write for them.

Student:
So that we can assess your level of English, please complete an essay in your own hand writing. This should be your own work with no assistance from anyone. Complete your essay on the topic below and upload it when done.

Essay Topic
What do you expect and what do you hope to achieve and during your time in New Zealand? What are your future career or study intentions for the future?

Essay Upload*

Max. file size: 256 MB.

Part Nine: Letter to Your Homestay Family

Write a letter introducing yourself to your homestay family and upload it below.

Letter Upload*

Max. file size: 256 MB.

Part Ten: Other Uploads

Please upload the other required documents to support you application.

Passport Photo*

Please upload a recent passport size photo.

Max. file size: 256 MB.

Passport*

Please upload a copy of your current, valid passport.

Max. file size: 256 MB.

Student Visa*

Please upload a copy of your student visa or copy of an email verifying that it is in process.

Max. file size: 256 MB.

School Reports*

Please upload a copy of your two latest school reports.

Max. file size: 256 MB.

Medical Certificate*

Please upload your Medical Certificate signed by a Doctor.

Max. file size: 256 MB.

Have you organised Medical and Travel Insurance?*

Medical and Travel Insurance are compulsory for all International Students while in New Zealand. If you have not organised Medical and Travel Insurance, Cullinane College can arrange it for you and you will be invoiced.

Yes

No, please have the School arrange and invoice us.

Medical and Travel Insurance Policy*

Please upload your Medical and Travel Insurance Documents.

Max. file size: 256 MB.

Contract Agreement and Decleartion

This agreement may be signed by only one parent if the student is legally the responsibility of that parent.

General (Parents)

The parties agree that all relevant provisions of the Education Act 1989 shall apply to the student in New Zealand. Any decision under these provisions to expel or exclude the Student will follow the Ministry of Education’s guidance for schools on stand-downs, suspensions, exclusion and expulsion and shall terminate this Contract.

Condition of acceptance: If this application contains incorrect information, the student will not be accepted into Cullinane College and if already accepted may have their application terminated.
We (parents or legal guardian/s) accept responsibility for the full payment of all tuition and homestay fees in advance.
We understand that in addition to fees paid to the school, we will be responsible for payment of any personal debts accrued by our son/daughter. We accept that the school can use the homestay money to settle any debt at any time.
That acceptance to a particular course is subject to the student’s level of English language being at the level appropriate to the course. If further tests after the student has reached New Zealand demonstrate otherwise, the school will approach the parents for any extra costs.
All students under the age of 14 must have a native speaking guardian.
In case of dispute, we accept that the New Zealand law applies at all times.
If the student has a pre-existing medical condition that is not disclosed at the time of enrolment and this medical condition makes education at Cullinane College difficult this non-disclosure is grounds for termination of this contract.
Cullinane College responsibility ceases at the time that the student leaves the school at the end of the period of enrolment.

Behaviour (Students)

Obey the laws of New Zealand. No student may take any illegal drugs or purchase alcohol.
Obey the school rules. Attend all classes regularly and always work to the best of your ability.
No student may drive a car or motorbike, without the permission of the School and their parents.

Safety

If travelling without your host family outside of Whanganui, you must obtain written permission from:
- Your own parents
- Cullinane College
If you are under 18 it is unlikely that the school will permit you to travel independently.
You must obtain written permission as above for higher risk/adventure activities e.g. Bungy jumping, white water rafting, skiing, small airplane sightseeing rides, or any activity that may be considered dangerous or high risk.
You must have permission from your parents and the school to travel in a car or motorbike with a driver younger than 25 years. The driver must have a full licence.

Homestay Rules

This Contract is subject to the Student being placed in accommodation that is approved by Cullinane College. Cullinane College will make every reasonable attempt to provide approved accommodation for the Student and the Student agrees to comply with all expectations and conditions for living in Cullinane College approved accommodation.

It is expected that you will become a member of the host family. As such, you will be treated as a member of that family and will be expected to participate in family activities. You are required to do the following:
- If you are going out, ask permission first and explain when you will be home.
- If you are likely to be late home, telephone or text your family.
- Be home by the time set by the homestay family. No later than 10:00 pm.
- Keep your bedroom tidy.
- No consumption of alcohol or recreational drugs are permitted.
- Help around the house. Accept responsibility for reasonable jobs, e.g. help with the dishes.
- You will pay for your toll calls and internet charges. Your host family may choose to control your access to the internet.
You may not stay overnight at any house unless has been confirmed by the International Director.

The Education Act 1989

The Education Act 1989 controls the exclusion, suspension and expulsion of all students from school. The Education Act also applies to international students.

Refund of Tuition Fees

If you withdraw from your course of study before the course completion date, you may be eligible for a partial refund of school fees.
An application for refund of fees must be made in writing. Your parents must write to the Board of Trustees explaining why you have withdrawn from the course and your reasons for seeking a refund.
If your application is made before the start of your course, your tuition and homestay fees will be refunded less a cancellation charge of $600 to cover costs incurred by the school.
If your application is made after the start of your course, but before eight school weeks, your fees will be refunded less:
- A cancellation charge of $600
- Any commission paid to your agent
- The proportion of the Government Levy the school is required to pay
- 60% of the remainder of the tuition fee (this covers costs already incurred and committed to for the duration of the programme for the use of facilities, resources and salaries of teachers and support staff).
No refund will be made to a student who is expelled from the school by the Board of Trustees.
No refund will be made to a student enrolled who becomes a permanent resident.
Administration fee will not be refunded.

Refund of Homestay Fees

Early end of the course will have homestay fees for the future weeks refunded.
If you move out of your homestay before the end of your contract, the portion of your homestay fees not already used will be returned to you. The Administration Fee will not be refunded.
If you cancel your homestay contract before you move into the homestay, your fees will be refunded in full less the administration fee.
If you request a change of homestay, then the original homestay will receive two weeks’ fees in lieu of notice.

Code of Practice for the Pastoral Care of International Students

Cullinane College has agreed to observe and be bound by the Code of Practice for the Pastoral Care of International Students published by the Minister of Education. Copies of the Code are available on request from this institution or from the New Zealand Ministry of Education website at nzqa.govt.nz/providers-partners/education-code-of-practice.

Dispute Resolution Scheme

As an approved institution of the Code of Practice, Cullinane is also bound by the Disputes Resolution Scheme (DRS) rules and bound by any decision made by the DRS operator, Fairway Resolution Ltd. If you require assistance to resolve a compliant with Cullinane College, please follow the procedure and Information about Fairway Resolution can be found online at istudent.org.nz.

Eligibility for Health Services

Most students are not entitled to publicly funded health services while in New Zealand. If you receive medical treatment during your visit, you may be liable for the full costs of that treatment. Full details on entitlements to publicly funded health services are available through the Ministry of Health, and can be viewed on their website at health.govt.nz.

Accident Insurance

The Accident Compensation Corporation provides accident insurance for all New Zealand citizens, residents and temporary visitors to New Zealand, but you may still be liable for all other medical and related costs. Further information can be viewed on the ACC website at acc.co.nz.

Medical and Travel Insurance

We require that all international students at Cullinane College have insurance that will cover the cost of any medical treatment and the loss of personal effects for the duration of their stay in New Zealand. The school is able to purchase a comprehensive policy from Unicare. If a student has alternative travel insurance, then please provide details of this policy for our records.

Immigration

Full details of visa and permit requirements, advice on rights to employment in New Zealand while studying, and reporting requirements are available through the New Zealand Immigration Service, and can be viewed on their website at immigration.govt.nz/new-zealand-visas.

I have read and understood these conditions applying to entry to Cullinane College. I agree to notify Cullinane College of any contact detail changes.

Student Declaration

I have read and understood the conditions of being an international student at Cullinane College and agree to abide by the rules of the school:

The student’s parent guarantees the good behaviour of the student in New Zealand. He/she understands that behaviour which is unacceptable to the school as outlined in the Code of Conduct nzqa.govt.nz/providers-partners/education-code-of-practice/ or to homestay parents may lead to termination of the student’s enrolment at Cullinane College.
Unacceptable behaviour” includes the abuse of alcohol and drugs, theft, physical violence, or any action that contravenes New Zealand law. In the event of such misbehaviour, any decision made by the Principal and / or Board of Trustees will be regarded as final.
The student’s parent accepts the right of the school to effect a change of course if this is seen to be in the best interests of the student.
The student’s parent has read and understood the Cullinane College Refunds Policy for International Students.
The student’s parent understands the student may not own or drive a vehicle whilst a student at Cullinane College. Driving lessons with an approved professional driving school can be arranged through the director.
The student’s parent agrees that the student should attempt to speak English at all times on campus and at his/her homestay.
The student’s parent agrees that their son/daughter should take part in at least two out-of-school activities each year, for example, music, speech or sport.
The student’s parent understands that the Principal, Director or Homestay Parents have the authority to make decisions regarding medical treatment for their son/daughter. The student’s parent understands that they will be informed immediately in the case of an urgent problem.

If I am living in a homestay organised by Cullinane College. I agree to abide by the homestay rules and guidelines and to do my best to fit in with the lifestyle of my homestay family.

Note: Failure to disclose relevant information or the provision of false information may result in termination of enrolment. Make sure all details on these forms are completed and signatures from the correct people are included.

Student Name*

First Last

Student Signature*

Mother's Name

First Last

Mother's Signature

Father's Name

First Last

Father's Signature

If you relied on a translator to understand this document, please ask the translator to sign here.

Translator's Name

First Last

Translator's Signature