(online)
Enrolment Form
PERSONAL DETAILS
*
Family Name
Given Name
Female
Male
Date of Birth
Day
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Year
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2007
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2009
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2011
2012
Nationality/Country
Passport No.
Type of Visa
Visa Expires
Day
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Month
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Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
Address (Street name)
Phone
State or Province
Fax
Your Email Address
Mobile
Your English Level
Elementary
Lower-Intermediate
Intermediate
Upper-Intermediate
Advanced
Accommodation Details:
Homestay
Flat
Apartment
COURSE DETAILS
*
General / Academic English
IELTS Preparation
Study Holiday
NZIM Diploma in Management
New Zealand Diploma in Business (Level 6)
Diploma in Business (Advanced) Level 7
National Certificate In Horticulture (L4)
Diploma In Horticulture (L5)
National Diploma in Computing (Level 5)
National Diploma in Computing (Level 6)
National Diploma in Computing (Level 7)
If you have selected New Zealand Diploma in Business
Please select NZDB course you want to apply
Accounting
Banking and Finance
International Business
Information Systems
Law
Management
Marketing
Small Business Management
Start Date
Day
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31
Month
1
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5
6
7
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10
11
12
Year
2012
2013
2014
Number of Weeks
Please select
1
2
3
4
5
6
7
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52
1.Full-time
2.Part-time(AM)
3.Part-time(PM)
HOMESTAY DETAILS
Do you require RIEG to arrange homestay?
Yes
No
Homestay Preference
with children
without children
no smoking
with pets
without pets
no preference
Do you have any health problems or allergies?
Yes
No
if Yes, please specify
Please specify if you have any other requirements.
What are your hobbies and interests?
DURATION
Please select
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Weeks
from
Day
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Month
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Year
2012
2013
2014
2015
2016
to
Day
1
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Month
1
2
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5
6
7
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9
10
11
12
Year
2012
2013
2014
2015
2016
MEDICAL
Do you suffer from any medical conditions which may influence your safe paricipation in school activities?
Yes
No
If yes, please give details
TRANSFER SERVICE
Do you require Airport Transfer?
Yes
No
If Yes, please inform us of your flight details two weeks before you arrive in New Zealand.
DECLARATION
I understand and accept the conditions of enrolment (
click here to read
). I declare that the information provided on this form is true and correct.
06 February 2012
FOR OFFICE USE ONLY
Application Number:
520 Queen Street, Auckland City, New Zealand Ph: 0064 9 9206888 Fax: 0064 9 9206880 Email:
info@rieg.ac.nz
