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    ▶ General English with
       Conversation
    ▶ General English with
       Reading & Writing
    ▶ General English with
       TOEIC
    ▶ English for Living and
       Working
    ▶ Part time courses
    ▶ IELTS Preparation
    ▶ ECN High School
       Preparation
    ▶ TESOL Course
    ▶ Certificate in TESOL
    ▶ English plus Diving
    ▶ English with NZ
       Business knowledge
    ▶ English plus Farmstay
    ▶ Senior Programme
    ▶ Short Group course
    ▶ IELTS Preparation
    ▶ Essay & NCEA English
    ▶ Fees
    ▶ Refund Policies
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You are applying for a course at ECN English Academy .

•  Fill out the online form below

•  Download the print version and mail or fax it to us: Word

•  If you have any question before you apply for a course, please contact us

 
* fields are required
Personal details
* First name(Given)
* Last name(Family)
* Gender Male    Female
* Date of Birth (Date/Month/Year)
* Nationality
* Address
  Phone (incl. country and area codes)
  Fax (incl. country and area codes)
* E-mail
  Address
  (New Zealand)
  Phone (incl. country and area codes)
  Fax (incl. country and area codes)
  Type of Visa
  Visa expires
 
Course details
  General English

General English with Conversation / Full time

General English with Reading and Writing Skills / Full time

English for Living and Working / Full time

General English with TOEIC / Full time

General English / Morning Part time

General English / Afternoon Part time

  IELTS Preparation Foundation IELTS Preparation / Full time

Intensive IELTS Preparation / Full time

IELTS preparation / Morning Part time

IELTS Preparation / Afternoon Part time
  Youth Programme High School Preparation / Full time

Child and Parents
  Teacher Training Tesol Course

Certificate in TESOL
  General English plus Farmstay

Sports: Dive

Work Experience

New Zealand Business knowledge
  Date you wish to start? (Date/Month/Year)
  How long do you wish to stay? (weeks)
 

Insurance details

All students are requited to have medical/travel insurance

I will send proof of insurance or arrange it myself

Please organise it for me

Uni-care Educational Travel Insurance Service (www.uni-care.org)

Premier     Protector     Partnership

 

Accommodation details

Would you like homestay accommodation?

Yes     No

How long do you wish to stay?

(weeks)

Is there any food you cannot eat?

If yes, please state

Do you smoke?

Yes     No

Do you have any health problems or allergies?

If yes, please state

Homestay Preference

With children       Without children

With pets           Without pets

Sharing a room with other student
Your Interests

Hobbies 

Sports   

 
Arrival Details

Arrival Date & time

Airline & Flight Number

Do you want airport pick-up Service?

Yes     No
 
Declaration(Parents/Guardian to sign if the applicant is under 18 years old)

I declare that the information set out in this application is correct and complete and I have not withheld any information.

I will observe the regulations and rules of conduct while studying at ECN English Academy.

I have read, understand and agree with the refund and behaviour polices included in the Conditions of Enrolment.

Signature   Date                                                                          (Date/Month/Year)

 

Where did you find out about ECN English Academy?

Study guide        Former Student        Friend/Relative

Internet             An educational agent