Please fill this form out and bring it with you to the interview.
Student's full name (as shown on passport): |
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Preferred English name (if so desired): |
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Male/female: |
Date of birth: |
Home address: |
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Country of citizenship: |
Ethnic group: |
Religion: |
First language: |
Previous English language tuition: |
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Intended date of arrival to New Zealand: |
Passport Number: |
Intended length of time to study at St Pius X School: |
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Will there be an accompanying adult travelling with you?: |
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If so, name and relationship to student: |
Full name of Father: |
Occupation: |
Full name of Mother: |
Occupation: |
Full postal address: |
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Home phone: |
Work phone: |
Facsimile: |
Email: |
Name of Company: |
Agent's full name: |
Full postal address: |
Phone: |