How to Apply

Application Form

INSTRUCTIONS

The purpose of this application form is to get from you the information we need to offer you a place and to enrol you into a course at Cornell. We also need to collect information from you which is required by the Ministry of Education and other Government agencies for statistic al registration reasons.

Please carefully complete :

All sections of the form.
In English Using CAPITAL LETTERS and tick the appropriate box.
And supply additional documentation that may be required

STUDENT DETAILS


Family Name		Given Name(s)
Nationality		Passport No.
Visa Expiry Date		Visa Type
Date of Birth	(2011-01-01)	Sex	Male Female
Home Address
Telephone		Fax
E-mail
Mailling address for documents : (if different form home address)

Address in New Zealand (if known) :
Telephone		Fax

If you are registered with NZQA and have an NSN please write it here:

HIGHEST PREVIOUS EDUCATION

Previous Institution Attended
High School College University
Name of Highest Qualification
English Test	IELTS TOEFL OTHER Score
Have you studied at Cornell before? Yes No
If you answered Yes, what was your Student ID number?

ACCOMMODATION AND AIRPORT PICKUP ( optional for 18yrs+ )

If you under 18
then, you must choose one of the following 3 options of accommodation. Other students ( 18yrs+ ) who also want accommodation should indicate below including Student Hostel
Homestay Designated caregiver Living with parents
If you choose Homestay
How many weeks?
Room	Non-smoking
Food or animal allergy
Do you want to be picked up at the Airport?		Yes No
Arrival date and time
Airline Name		Flight No

Courses :

English for International Communication (4 to 48 weeks)
English for Business (4 to 24 weeks)
English for IELTS / TOEFL (4 to 24 weeks)
OET (The Occupational English test) (16 to 32 weeks)
TESOL (8 weeks)

LENGTH AND INTAKE DATES (English courses only)

How long do you wish to study English at Cornell weeks
Start Date
Course	Full Time Part Time

STARTING INTAKE / SEMESTERS

INTAKE Dates for : (Please refer exact intake dates to page 3)
Intake 1 Intake 2 Intake 3 Intake 4 Intake 5

FURTHER STUDY IN NEW ZEALAND

Will you take further study in New Zealand ?			Yes No
If Yes, have you already arranged a place?			Yes No
Will you take further study in New Zealand ?			Yes No
If Yes, have you already arranged a place?			Yes No

GUARDIANSHIP

Yes No
It is a condition of enrolment that all students under 18 years of age must have an adult caregiver in New Zealand. Do you need Cornell to arrange a caregiver?
if No, who is your caregiver?
Caregiver's full name
New Zealand address
Phone (Home)		Mobile
E-mail		Relationship

CITIZENSHIP/ RESIDENCY

Yes No
What is your citizenship?
Do you have Permanent Residency in New Zealand?
If Yes, you must attach a certified copy of your Residency Permit. Declaration of IRD number for full student loan interest write-off If you are a Domestic student and have a Student Loan, or will be getting one, you may be entitled to have the interest written off for the period you are studying. IRD Number

PAYMENT DETAILS (All fees are quoted in NZ$ and include GST)

Student fee payment schedule will be issued upon the receipt of application form, all supporting documents and a copy of the student's passport.

PAYMENT OF FEES

Fees are due for payment, before the start of your programme of study. (Please note that payments may be made by cash, bank cheque, bank draft or telegraphic transfer). Please attach payment or indicate payment method:
Cash (Paid at Cornell office) Telegraphic Transfer Bank cheque Bank draft

BANK CHEQUE or BANK DRAFT payable to:
Cornell Institute of Business and Technology Ltd.
(Cornell P.O. Box 911144 A.M.S.C., Auckland, New Zealand)

TELEGRAPHIC TRANSFER (In NZ$ only)

Account Name : Public Trust Cornell Institute of Business - HQ
Account No. : 02 0536 0305865 01
Reference No. : 7693486
Particular : Your quotation number starting with “Q”
Bank : Bank of New Zealand North End Branch. Wellington, New Zealand
Swift code : BKNZNZ22

How did you find out about Cornell?

Do you agree with our Terms and Conditions of Enrolment?

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