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Application Form

All fields are mandatory

First Name*

Last Name*

Date of Birth*

Gender

Male Female

Email Address*

Course Applying for

Advanced Diploma
Bachelor Degree
Postgraduate Diploma
English Language

Preferred Intake Date

2010 September
2011 January
2011 April
2011 July
2011 September

Full Address*

Country of Residence*

Postal or Zip code*

Are you a

NZ citizen
NZ Maori
NZ Permanent Residen
International Student

Additional comments

International Students Only:

Passport Number

Country of Issue

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