APPLY ONLINE

Personal details
Name:
Title Surname First name(s)
Nationality:
Date of birth:
Day Month Year
Current address:
Street City Country
Telephone Mobile phone E-mail
Current level of English:
Where did you hear about our Institute?:
Which course would you like to enrol in?
INTENSIVE ENGLISH COURSE: Yes PREPARATION FOR CAMBRIDGE EXAMINATIONS: Yes
I would like to book HOMESTAY
Length:
From To Number of weeks
Do you smoke:
Yes No
Do you have any medical condition or any special requirements regarding your accommodation? : Yes
eg. allergies, etc :
Personal interests/ hobbies:
MEDICAL AND TRAVEL INSURANCE
I would like to apply for the Uni-Care NZ Student Plan Insurance Policy : Yes
I am organising my own insurance covering my medical costs, travel expenses and school fees : Yes
I have read and accepted the Conditions of Enrolment at Aspiring Language Institute : Yes