If you are unsure of anything, please contact us! REQUEST INFO Application Form Please fill in the form as much as possible. We will respond within the next 3 working days. Student DetailsWhere are you from?*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweGender*MaleFemaleFamily name*Given name*NationalityDate of birth* DD MM YYYY Passport number*Passport expiry date DD MM YYYY Visa expiry date DD MM YYYY Address (home country)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone numberMobile*Email* Emergency contact name*Phone of emergency contact*Are you in New Zealand or is your New Zealand address already known?*YesNoAddress (New Zealand)* Street Address Address Line 2 City ZIP / Postal Code Phone number (New Zealand)Mobile (New Zealand)*Previous EducationPrevious institution attended*High schoolCollegeUniversityName of the previous institution*Name of the highest qualification*Your current level of English*ElementaryIntermediateAdvancedEnglish testIELTSTOEFLOtherScore of the testHave you studied at Regent before?*YesNoWhat was your Student ID number?If you have an NSN please write it here:Homestay DetailsPlease contact us to complete homestay application form.Do you require Regent to arrange homestay accommodation?*YesNoHow many weeks?*4 weeks5 weeks6 weeks7 weeks8 weeks9 weeks10 weeks11 weeks12 weeks13 weeks14 weeks15 weeks16 weeks17 weeks18 weeks19 weeks20 weeks21 weeks22 weeks23 weeks24 weeksDo you have any health problems or allergies?*YesNoPlease specify*Do you want to be picked up at the Airport?*YesNoDo you have any Special needs when you study with us? if yes, please specify: Medical and Travel InsuranceDo you have current Insurance?*YesNoPlease provide your insurance details*International Students must have appropriate and current Medical & Travel Insurance while studying in New Zealand.Course DetailsCourse required (please select one or more from the following)English courses New Zealand Certificate in English Language General English and IELTS Preparation How many weeks do you wish to study English?*Type of English course*Full-timePart-timeBusiness New Zealand Diploma in Business (Level 5) New Zealand Diploma in Business (Level 6) Diploma in Business (Advanced) (Level 7) Choose your major*ManagementMarketingInternational BusinessBusiness Information TechnologyAgribusiness ManagementChoose your major*Leadership and ManagementAccountingInformation Technology Diploma in Information and Communication Technology (Level 7) New Zealand Diploma in Information Technology Technical Support (Level 5) Choose your major*System AdministrationMultimedia Software DevelopmentNetwork and SecurityHorticulture National Certificate in Horticulture (Level 4) Diploma in Horticulture (Landscaping) (level 5) Plan Start From* DD MM YYYY How did you hear about us? Please specify*If your enrollment is through education consultant, please clearly specify their company name above.Any other information or inquiry that you would like to tell us File Drop files here or Please, upload your documents required to process your application. Refer to Documents required to enrol.pdf to find out what documents you need to submit with your application.PrivacyRegent International Education Group collects and stores information from this form to comply with the requirements of the Ministry of Education(funding and student statistical returns), New Zealand Qualifications Authority (Record of Learning registration and Unit Standard outcomes), Skill New Zealand (funding and student statistical returns), Industry Training Organizations (funding and academic outcomes), Department of Work and Income (confirmation of enrolment and academic outcomes). The information is also used to select students for qualifications, to manage internal administrative processes, and for internal reporting. Information about students may be supplied to, and sought from, other educational institutions for the purpose of verifying academic records. In addition, when required by statute, Regent International Education Group releases information to Government agencies such as the New Zealand Police, Department oflustice, Department of Work and Income, and the Accident Rehabilitation Compensation Corporation (ACC), INZ, agents and parents. In signing this enrolment form you authorise such disclosure on the understanding that Regent International Education Group will observe the general conditions governing the release of information, as set out in the Privacy Act 1993. You may see any information held about you and amend any errors in that information. To do so, contact the person who enrolled you. You agree to abide by the statutes, regulations and policies of Regent International Education Group.Declaration by Applicant(over 18 years of age) or Parent/Legal Guardian of Applicant (under 18 years of age): I declare that to the best of my knowledge all the information supplied on and with this enrolment form is true and complete. I confirm that I have read all the relevant information regarding my courses, I declare that the courses is meets with my needs, I believe that I can participate effectively in the courses. I have read and accept the terms and conditions of enrolment and refund policy and I consent to the disclosure of personal information as described above. I agree to pay all fees as they become due and to meet any late fees. In signing this Application Form I agree to comply withthe rules and policies with regard to attendance, academic progress, health and safety and behaviour and refund policy as outlined at www.regent.ac.nz* I agree with terms and conditions above and all the information that I provided is honest and valid.
