Abacus Institute of Studies
Enrolment Form
TO BE COMPLETED IN ENGLISH
ACCOMODATION ARRANGEMENTS
PRINT CLEARLY IN PEN REFER TO TERMS & CONDITIONS AND PRIVACY POLICY
Please ck one:
PERSONAL INFORMATION
I require Abacus Ins tute of Studies to assist with Home stay accommoda on
Surname or Family Name (s)
advise my address and contact details to Ins tute arrival.
I will make my own accommoda on arrangements. I will
(Please be advised We need to know where you are living at
First or Given Name
If you need us to make Homestay arrangements for you please complete homestay details below:
Preferred Name Please ck relevant boxes. You can choose more than one op on:
Date of Birth (dd/mm/yyyy)
You will prefer family with: No Children
Passport Number
Issuing Country
Teenage Children
N o C h ild r e n
Pe ts
D o e s n o t m a tte r
Gender
M
F
Ac vi es / Hobbies:
Home Address Home Country Address Street
Suburb Town/City
Country
Fax
Any Comments / Religious / Cultural Requirements:
New Zealand Address (if Known) Street
Suburb Town/City
Country
Fax Do you require special meals ( e.g vegetarian )
PROGRAM OF STUDY
Do you drink Alcohol
Please ck the relevant box:
Do you require Halal food?
Na onal Diploma in Business (Level 5)
Do you smoke
Yes
No
Na onal Diploma in Business (Level 6)
APPLICATION CHECKLIST
(Most NZ families do not allow smoking inside homes arranging your accommoda on:
Please attach copies of your study, mark sheets, experience in English:
Expected Date of Arrival
Entrance QualiďŹ ca on and Academic Records IELTS / Proof of English Language ability Details of work experience, CV and reference etc.
requested by you subject to availability
MEDICAL AND INSURANCE
EMERGENCY CONTACT DETAILS
Do you want us to arrange Insurance for you:
Yes
No
comprehensive health & travel insurance. If you do not provide the proof of insurance by start of your course date, Abacus will take out and Insurance policy on your behalf, at your cost, from our preferred insurance providers. 1. Southern Cross Insurance 2. Uni-care
Name Address: Country
Postcode
Phone
Mobile
Fax
CODE OF PRACTICE
WITHDRAWL AND REFUND Withdrawal /Refund
1 – 34 days (Less than 5 weeks, interna onal students only)
Withdrawal period
Within the first two days of the course
Amount of refund
50% of total fees paid
NEW ZEALAND PRIVACY ACT
CONDITIONS OF ENROLMENT
viewed on their website at www.moh.govt.nz
35 days – 3 months (Between 5 and 13 weeks, interna onal students only)
two days
Within the first five days of the course
More than 3 months (Greater than 13 weeks, all courses/students)
A er more than five days
Within the first eight days (i.e., seven days a er the first day of the course)
No refund is available No refund is available
75% of total fees paid
A er more then eight days
No refund is available costs of upto 100% of the total free of $500 whichever is the lesser of the two.
STUDENT DECLARATION • • • • • • • • • • •
I understand that the making of a false declara on is an offence under the Crimes Act 1961. I agree to abide by the Statutes, Regula ons, Rules, Codes and Policies of Abacus Ins tute of Studies. I acknowledge that my enrolment is not complete until I have provided all relevant personal informa on, established my iden ty, and paid all the relevant fees and charges in accordance with the Ins tute’s Terms and Condi ons of Enrolment and I acknowledge that I am not en tled to a end any class un l my enrolment is complete. I accept that a endance at any class will make me liable for all fees and charges I hereby declare that the informa on I have given on this form is true and correct I understand that this data may be sent over the internet unencrypted and therefore total security can be ensured. I understand that I must be at least 18 years of age I will a end all classes except in case of illness (when I must provide a Medical Cer ficate). I understand that Immigra on NZ will be no fied if due to poor a endance and progress my enrolment is cancelled. I have read and accepted the condi ons of enrolement and acknowledge receipt of the informa on.
Signatures of Applicant
Date
HOW DID YOU HEAR ABOUT US
AGENT DETAILS Newspaper
Family
Internet ? Which website Friend
Others (Please specify)
Agent ID Agent Telephone Agent Name Agent Email
FOR ABACUS INSTITUTE OF STUDIES (OFFICE USE ONLY)
Received By
Date
Completed By
Level 1 Science Alive Building, 392, Moorhouse Avenue, Christchurch, New Zealand – 8011
www. Abacusins tute.ac.nz