SIEBA New Zealand

International Student Primary School Programme - Application Form

Fields marked with * are required.

Student Details
First name (must be as it appears on your passport)
*
Middle names (must be as it appears on your passport
Last name (must be as it appears on your passport)
*
Preferred first name
Date of Birth
*
The Education (Pastoral Care of International Students) Code of Practice 2016 requires that all students under the age of 10 must live with a parent for the duration of their enrolment at school in New Zealand.
Country of citizenship
*
Gender
*
Ethnicity
*
First language
*
Address (in home country)
*

*
*

*
Phone number (in home country)
+--
New Zealand mobile number
Email address
*
How long have you studied English
Years Months
Level of English
Sporting Interests
Other:
Cultural Interests
Other:
Agency Details (if using an agent)
Agency name
Agent name
Agent email address
Previous Applications
What is the name of the school you currently attend?
Have you applied to this NZ school before?
If yes, when?
Have you studied in New Zealand before?
If yes, please state which school
Has your brother or sister enrolled at this NZ school before?
Full Name
Year Attended
Travel Details
Arrival date (if available)
Passport number (if available)
Passport expiry
National ID Number (Chinese students Only)
*
Student Visa number (if available)
Student Visa issued
Student Visa expiry
Parents or Legal Guardian Details
Parent One or Legal Guardian Details:
First name (must be as it appears on passport)
*
Middle names (must be as it appears on passport)
Last name (must be as it appears on passport)
*
Relationship (eg mother, father, legal guardian)
*
Occupation
Current address
*
*

*
Phone number (in home country)
+--
Work number
+--
Mobile number
+--
Email address
*
Passport number (if available)
Parent Two or Legal Guardian Details:
First name (must be as it appears on passport)
Middle names (must be as it appears on passport)
Last name (must be as it appears on passport)
Relationship (eg mother, father, legal guardian)
Occupation
Overseas address




Phone number (in home country)
+--
Work number
+--
Mobile number
+--
Email address
Passport number (if available)
Accommodation Details
The Education (Pastoral Care of International Students) Code of Practice 2016 requires that all students under the age of 10 must live with a parent for the duration of their enrolment at school in New Zealand.
Where will you be staying? *
Homestay Information
Letter to Homestay
Please write a short letter (below) to introduce yourself to your new host family. Tell them what you like, why you are coming to New Zealand and anything else you want them to know.
*
Important Homestay Considerations
Please include any important homestay requirements, such as vegetarian, or that you are allergic to cats etc. This information is used to help us choose the best homestay for you.
*
Designated Caregiver (DCG) Details
First name of caregiver
*
Middle names of caregiver
Last name of caregiver
*
Relationship (eg aunt, guardian, close family friend)
*
Occupation
New Zealand physical address
*



Phone number in NZ
*
Work number in NZ
Mobile number in NZ
Email address

Please note: A DCG must be a relative or close family friend of the family. This accommodation must be approved by the School prior to the student's arrival. Please provide a copy of the passport (and visa if applicable).

Medical Details
Do you wish to purchase insurance through the school? *

Insurance must cover travel and health for entire length of stay in New Zealand.

Insurance company
Insurance policy number
Insurance policy expiry
Have you been vaccinated for any diseases? (If Yes, please upload an English copy of your vaccination certificate below)
*
Permission is given for the School to administer Paracetamol?
*
Permission is given for the School to administer Ibuprofen?
*
Medical Conditions
Does the student have any of the following medical conditions:
ADD/ADHD Asthma Back/Neck problems Glandular Fever Migraines Diabetes Hepatitis A, B or C Depression/Anxiety Heart Condition Mobility Issues Tuberculosis Food Allergies Eating Disorders Epilepsy Bee/Wasp Sting Allergy Any Mental Illness HIV or AIDS Covid-19 Aspergers Autism
Additional Medical Information
Does the student have any pre-existing medical conditions (for insurance purposes) or history of previous illness that may affect the enrolment, including mental illness? If 'Yes', please provide details. Withholding information may result in your contract being terminated.
Current Medications
If the student sufferes from conditions requiring medication, it is advisable to bring their own medication to New Zealand. You will be required to notify the school regarding any medications that you bring with you. The school WILL dispense any over the counter medications as it sees fit to students UNLESS specified below.
Allergies
Doctor name (in home country)
Doctor phone
+--
Emergency Contact (In your home country, other than your parents)
First name (name must be as it appears on your passport)
Last name (name must be as it appears on your passport)
Relationship to the student
Phone number (in home country)
+--
Address
Email address
Course Details
School Choices
Study Programme
When will you start?
Year * Term * Duration * Terms
Start: *
Finish: *
Year/Subjects
Learning and/or behavioural difficulties
Does the student have any learning or behavioural difficulties which may require extra support or services? Please provide details. Failure to notify of any difficulties may result in your enrolment being terminated.
Comments
Is there anything further that the school needs to be aware of in enrolling the student as an international student? If 'Yes', please provide details.
Declarations

COMPULSORY: You MUST download, complete and scan (or photograph) the form containing the Declarations and upload it in the 'File Uploads' section below under Signed Declaration.

All Contract Documents must be fully read and understood and the Declaration Form signed as confirmation of this. To access these Contract Documents and the Declaration Form, please click this link declaration form

File Uploads
Passport
Your Photo
Last School Report
Other file
Vaccination Certificate
*
Insurance Certificate
Signed Declaration (see above)
*