- Accommodation Questionnaire - A. Name: Family Name: Given Name: Address: Fax: Telephone: Email: Nationality: Date of Birth: day month year B. Home-stay Arrangements This will be a warm, comfortable room of your own with a family who will provide all your meals and arrange laundry. Cost: NZ$220 per week = NZ$9 900 for 45 weeks in a calendar year, plus non refundable Placement fee NZ$200(including GST ) Total NZ$10 100 Home-stay fees to be paid to the school in advance. Payment is due when you receive an offer of place. A. Please answer the following questions: Yes No 1 Are you a vegetarian? 2 Is there any food you cannot eat? (Detail below) 3 Do you require any special foods? (Detail below) 4 Do you have any special religious observances?
5 Do you have any allergies? (On Medical Form) 6 Are you happy with younger children? 7 Do you object to cats or dogs in your home? 8 Do you smoke? 9 Do you drink alcohol in your home? (Details from above) 10. What are your hobbies and interests? e.g. Do you require use of a piano, etc? 11. Please make any other comments that will help us to make your stay a happy one. International Student Application Form Central Southland College Student Details Name of Student Family Name: Preferred Name First Names:
Ethnicity Male / Female Country of Birth Date of Birth Citizenship (Or permanent resident of) Passport Number First Language From: To: Length of time International student wishes to enrol for: / / / / Passport,Student visa and student permit photocopied Family Details Mother s Name: Occupation: Mother s Home Address: Mother s Business Address: Telephone : Day: Night E-mail Fax Father s Name Occupation: Father s Home Address: Father s Business Address
Telephone : Day Night E-mail Fax Number of Brothers Number of Sisters Emergency Contact In Home Country: In New Zealand (if known) Name: Name: Address: Address: Phone: Day Phone: Day Night Night Accommodation Central Southland College will arrange accommodation for international students. This will be a warm, comfortable room of your own with a family who will provide all your meals and arrange personal needs such as laundry. 1. Any accommodation to be used by international students will have:
- An on-site assessment to determine that living conditions are of an acceptable standard. - If a home-stay or designated caregiver, an assessment to determine that the accommodation type is not a boarding establishment. - An assessment of the residential carers suitability and whether they will provide a safe physical and emotional environment. 2. Each student will be interviewed quarterly to ensure that their accommodation is suitable. 3. All accommodation residences will be visited at least twice yearly to ensure that they remain suitable. 4. Police vetting will be carried out on all adults aged 18 years and over living in a home-stay, or designated caregiver accommodation used by a student. Cost: NZ$ 220 per week or NZ$9 900 per 45 week year, plus non refundable placement fee NZ$200 (including GST): Total: NZ$10 100 Home-stay fees are to be paid in advance. The first payment is due when you receive an offer of place. Please Circle which type of accommodation the student will be living in: School approved Home-stay Parent Relative or family friend If you require the school to arrange home-stay accommodation please complete and attach the Accommodation Information Form. Academic Programme Central Southland College expects to be able to meet the learning needs of children enrolled at the school. Does the International Student (named above) have any special learning or behavioural needs? Yes No Details if applicable: Course placement at a particular level is conditional upon a given level of English language proficiency or prior learning being achieved through thorough testing either in New Zealand or before arrival. We reserve the right to restrict entry into classes or courses when the required level of English is not achieved.
Attached: 1. Copies of your recent academic records. 2. Results of IELTS taken within the last six months. Preferred level of study: (subject to language levels of student) NCEA Level 3: Pre-University Year 13 NCEA Level 2: Year 12 NCEA Level 1: Year 11 Year 9 and 10 Preferred Subjects: Please list the subjects you would like to study at Central Southland College in order of preference: 1. 2. 3. 4. 5. 6. How long do you wish to study at Central Southland College? Do you wish to study further at Polytechnic or University? Yes No Health All International students enrolled at Central Southland College must be in good health and have Medical and Travel insurance. Please complete the Medical Authorisation form after this Enrolment form. Medical and Travel Insurance International students must have appropriate and current medical and travel insurance while studying in New Zealand. Central Southland College provides insurance at competitive rates through Unicare: www.uni-care.org Eligibility for Health Services Most international 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 cost of treatment. Full details on entitlements to health services are available through the Ministry of Health on their website at www.moh.govt.nz Accident Insurance
The Accident Compensation Corporation provides accident insurance for all New Zealand citizens, residents and temporary visitors, but you may still be liable for all other medical and related costs. Further information can be viewed on the ACC website at www.acc.co.nz Parents Declaration I have been informed about and received a summary of the Code of Practice for International Students: Copy of Summary Code YES NO I have been informed about all costs involved with enrolment and the school s policy Refund & Fees Regarding fee protection and refunds. Protection Policies YES NO I have received a copy of the school Prospectus and Policies relevant to International Students and have read and understood them. YES NO Prospectus Insert. Complaints Policy Parents Guarantee 1. I guarantee good behaviour of the student in New Zealand and he/she will obey all laws of the land. 2. I accept that the school will arrange an academic course, which will be in the best interests of the student. 3. I guarantee regular payment of fees and allowances. 4. I guarantee that my son/daughter will have medical and travel insurance. 5. I have read, understood and agree to the Refunds policy. 6. I understand that my son/daughter may not own or drive a vehicle whilst a student at Central Southland College unless: he/she obtains written permission from their natural parents requesting to own or drive a car: writes to the Principal outlining intentions/reasons for wanting to own or drive a car; permission has been granted by the Principal; have had lessons from a registered driving school; be 16 ½ years old or over; hold a current New Zealand driving license and undertake a Defensive Driving Course. 7. I agree that my son/daughter should attend school related outdoor education/day trips etc.
8. I can contact: Mr Turnbull at +64 3 236 0095 or 021 1793 793 Mr McSweeney Either at the school at +64 3 236 7646 Signed: Date: (Parent Signature) Full Name: Phone: Fax: School Guarantee Central Southland College agrees to provide tuition and pastoral care support (in accordance with the Code of Practice for the Pastoral Care of International students) for: Name of International Student For the period of: commencing / / Principal s Signature: Central Southland College Board of Trustees. Date / / on behalf of Application Approved Stamp: Documents required to complete this application process: Signed Application to Enrol as an International Student form Completed Accommodation Information form (if student requires homestay accommodation) Signed Contractual Agreement Signed Indemnity Form (If parents designate a relative or family friend to accommodate their son or daughter) Copy of Signed Contract to Applicant
Please Return this form as soon as possible to either your local agent or to: The Principal Central Southland College Grange St Winton New Zealand Telephone (0064) 3 2367 646 Fax (0064) 3 2367 645 email: office@csc.school.nz with: 1. Medical certificate and Medical Authorisation Form 2. Copies of Academic record and IELTS results 3. Accommodation Information Form Paid in full Receipt issued Medical Authorisation Form You must complete this form in ENGLISH. Please print carefully. I/We, the parents of authorise accredited staff at Central Southland College to obtain information from Hospitals or Medical Practitioners regarding the medical condition of our child. We expect that in the event of some serious condition or accident we will be advised immediately so that we can give permission for treatment and/or surgery. If, in the event of an emergency or accident we cannot be contacted, we give permission to Hospitals or Doctors to take whatever action they find appropriate after consultation with the school staff concerned. Name: Date of Birth: Address: Phone:
Previous Doctor: Name: Address: Phone: Please state any on-going medical problems i.e. Asthma, Diabetes, Hepatitis, etc. What is your past medical history (including operations): Family history: i.e. Asthma, Diabetes, Hypertension, Cancer. If so, please state: Are you currently on any medications? Please name: Do you have any allergies? i.e. to medications, insect stings, foods, etc. If so, please state: Immunisations: TETANUS YES/NO When? POLIO YES/NO DIPTHERIA YES/NO PERTUSSIS YES/NO MEASLES YES/NO RUBELLA YES/NO HEPATITIS B YES/NO If you have an on-going medical condition that may need attention, please bring the necessary medical records with you. SIGNED: DATE: 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: http://www.minedu.govt.nz/goto/international 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 http://www.immigration.govt.nz Eligibility for Health Services Most international 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 http://www.moh.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 http://acc.co.nz Medical and Travel Insurance International students must have appropriate and current medical and travel insurance while studying in New Zealand. N.B. Students must provide evidence of medical and travel insurance on enrolment. The insurance must cover the full length of time spent in New Zealand. An overseas Insurance policy will only be accepted if it is accompanied with an English translation. The school will keep a record of the Insurance Policy number and the type of cover provided. PRIME CONDITIONS OF ENROLMENT Central Southland College requires that all international students live in the following type of accommodation. 1. Living with a parent. 2. Living with a relative or close family friend (designated by the parents to accommodate their son or daughter) 3. In a school approved homestay. Peter Turnbull on 03 2367646 or petert@csc.school.nz