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Online Application Form

Fill out this form clearly. Indicate NO or NA if sections do not apply.

Personal Details
Family Name:* Given Names:* Middle Name:
Gender:*
Male Female		 Date of Birth:* (DD/MM/YYYY) Age:
 Nationality:*
Occupation: Email:*

Contact Details
Street Address:* Phone:*
Town/City: Mobile:*
Country:* Post Code:

Emergency Contact Details
Emergency Contact Person:* Relationship:*
Street Address:* Phone:*
Town/City: Mobile:*
Country/Post Code:* Email:*

Fees and Refund Policy
Kauri Academy NZ has a Fees and Refund policy. For more information refer to "Student Fee Protection Policy" section.

Programmes*
Please select the programme you wish to enrol:

For International Students Only
PASSPORT DETAILS Number: Country: Issue Date: (DD/MM/YYYY) Expiry Date: (DD/MM/YYYY)
PARTNERSHIP STATUS Single
Married/ in Civil Union		 Separated
Engaged		 Partner
Widowed		 Divorced
STUDENT RECRUITMENT AGENCY Are you applying through an agent?
Yes No
 If yes, what is the:
Agent's Name Email Contact No
MEDICAL AND TRAVEL INSURANCE

All international students are required to have appropriate medical and travel insurance while studying in New Zealand.  Kauri Academy will require evidence of an appropriate insurance policy at enrolment. In addition to the insurance policy Kauri Academy will also require the student to provide (in English) a written attestation from their insurance provider that the student’s travel insurance policy is consistent with the above guidelines for appropriate insurance for international students. For more information refer to "Health, Travel and Accident Insurance" section.  Tick the box that best applies to you:

I will organize my own medical and travel insurance I would like Kauri Academy to assist me organizing my medical and travel insurance

Declaration by Applicant*
I have read and I accept the terms and conditions for this application. I declare that the information provided by me in this form is correct and accurate and I acknowledge that the provision of false or misleading information or the withholding of relevant information may result in the cancellation of any offer of place for enrolment. I agree to Kauri Academy collecting, recording and disclosing information about me subject to the Privacy Act. I confirm that I have read and understood the Fee Information stated in the prospectus.




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