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Enrol to a PEETO program

Personal Information First Name:

Family Name:

House/Street:

Suburb:

Postcode:

City:

Country:

Find your New Zealand postcode on the NZ Post website.

Education Details Last educational institution attended :

Passport Details Passport Number:

Expiry Date (dd/mm/yyyy):

Contact Information E-mail:

Telephone:

Fax:

Alt. Contact:

Course Details Course Name/Type:

Course Option:
Full Time Part Time
Level of English:

Length of Study:
weeks
Course Start (dd/mm/yyyy):

Accomodation Type of Accomodation required:

Do you smoke?
Yes No
Do you mind smokers in the house?
Yes No
Do you mind children in the house?
Yes No
Do you mind pets in the house?
Yes No

Travel And Medical Insurance Have you submitted your Insurance application?
Yes
No

Personal Health Do you have any medical condition which you feel the college or homestay family should know about ?
If so, please give details :

Before you submit

Please make sure all the information provided is correct.
By submitting this form you agree to the Conditions of Enrolment.
Please not that PEETO operates a separate trust acount for student fees that meets NZQA student fee indemnification requirements.

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