St Dominic’s College

International Student Application Form

Fields marked with * are required.

Student Details:
First name (as on your passport):
*
Middle names (as on your passport):
Last name (as on your passport):
*
Preferred first name:
Date of Birth:
*
The Education (Pastoral Care of International Students) Code of Practice 2016 requires that all students under the age of 10 must live with a parent for the duration of their enrolment at school in New Zealand.
Country of Birth
*
Gender:
*
Ethnicity:
*
First Language:
*
Overseas Address:
*

*
*

*
Overseas phone number:
+--
New Zealand mobile number:
Email address
*
How long have you studied English?
Years Months
What do you consider your level of English to be?
What are your sporting interests?
Other:
What are your cultural interests?
Other:
Agency Details (Please complete if using an agent)
Agency:
Agent Contact Name:
Agent Contact Email:
Previous Applications:
What was the name of the last school you attended?
Have you applied to St Dominic’s College before?
If yes, when?
Have you studied in New Zealand before?
If yes, please state which school:
Has your sister enrolled at St Dominic’s College before?
Name:
What year did she attend?
Travel Details:
Arrival date (if available):
Passport number:
Passport expiry:
National ID Number (Chinese students Only)
*
Student Visa number:
Student Visa issued:
Student Visa expiry:
Parents/Caregivers Details:
Mother/Caregiver 1 Details:
First name
*
Middle names
Last name
*
Relationship (Mother,Father,Aunt,Guardian)
*
Occupation
Overseas address
*
*

*
Phone number
+--
Work number
+--
Mobile number
+--
Email address
*
Passport number
Father/Caregiver 2 Details:
First name
Middle names
Last name
Relationship (Mother,Father,Aunt,Guardian)
Occupation
Overseas address




Phone number
+--
Work number
+--
Mobile number
+--
Email address
Passport number
Accommodation Details
The Education (Pastoral Care of International Students) Code of Practice 2016 requires that all students under the age of 10 must live with a parent for the duration of their enrolment at school in New Zealand.
Where will you be staying? *
Homestay Information:
Letter to Homestay
Please paste in a short letter (below) to introduce yourself to your new host family. Tell them what you like, a little about your family, why you are coming to New Zealand and anything else you want them to know.
*
Important Homestay Considerations:
Please advise us of any important homestay requirements, such as vegetarian, animal likes or dislikes or allergies. This information is used to help us choose the best homestay family for your New Zealand experience.
*
Parent/Designated Caregiver (DCG) Details
First name
*
Middle names
Last name
*
Relationship (Mother,Father,Aunt,Guardian)
*
Occupation
Overseas address
*



Phone number
*
Work number
Mobile number
Email address

Please note: A DCG must be a relative or close family friend of the family. The accommodation must be approved and all members over the age of 18 in the home must undergo a police vet organised by St Dominic’s College prior to the student's arrival. Please provide a copy of the passport (and visa if applicable).

Medical Details
Do you wish to purchase insurance through the school? *

Insurance must cover travel costs, medical care, and costs associated with repatriation, expatriation and funeral expenses for entire duration of the stay in New Zealand.

Insurance company
*
Insurance policy number
*
Insurance policy expiry
*
Have you been vaccinated before? (If Yes, upload certificate below)
Permission for St Dominic’s College to administer Paracetamol as needed?
*
Permission for St Dominic’s College to administer Ibuprofen as needed?
*
Medical Conditions:
Do you have any of the following?
ADD/ADHD Asthma Back/Neck problems Glandular Fever Migraines Diabetes Hepatitis A, B or C Depression/Anxiety Heart Condition Mobility Issues Tuberculosis Food Allergies Eating Difficulties Epilepsy Bee/Wasp Sting Allergy Metal Implants Any Mental Illness HIV or AIDS Other
Additional Medical Information:
You must declare all other medical details. Withholding information may result in your contract being terminated. St Dominic’s College WILL dispense any over-the-counter medications as it sees fit to students such as paracetamol / ibuprohen, UNLESS specified below.
Current Medications:
Allergies:
Doctor name (in home country):
Doctor phone
+--
Emergency Contact (If other than parent)
First name:
Family name:
Relationship:
Phone number:
+--
Address:
Email address:
Course Details
Study Programme:
When will you start?
Year * Term * Duration * Terms
Start: *
Finish: *

INFORMATION REGARDING SUBJECT SELECTION:

Course choices are only an indication of the subjects you are interested in and will be reviewed on your entry to school.
Please also consult the Curriculum handbooks for Junior and Senior Students for further information.

Year 7:
In Year 7, all students take English, Maths, Science, Technology, Social Studies, Music, Religious Education (R.E.), and PE & Health throughout the year. Students also take half a year each of Te Reo Maori and Chinese and one term each of Drama, Dance, Art and Project Based Learning.

Year 8:
In Year 8, students all take English, Maths, Science, Technology, Social Studies, Religious Education (R.E.), and PE & Health throughout the year. They will also take half a year each of Te Reo Maori and either Japanese or French and one term each of Drama, Dance, Art and Music.

Year 9:
In Year 9, students all take English, Maths, Science, Technology, Social Studies, Religious Education (R.E.), and PE & Health throughout the year. They will also take a language of their choice (numbers permitting) for the year and one term each of Drama, Dance, Art and Music.

Year 10:
In Year 10, students take English, Maths, Science, Social Studies, Religious Education (R.E.), and PE & Health throughout the year. In addition to these, please choose three other subjects.

Year 11:
Please choose 6 subjects.

Year 12:
Please choose 6 subjects.

Year 13:
Please choose 6 subjects

Year/Subjects

Learning Difficulties:
You must declare any learning difficulties you may have. Failure to notify of any difficulties may result in your enrolment being terminated.
Comments:
Is there anything else you would like to tell us in support of your application?
Declarations:

Please download print and sign the declaration form, then scan it and attach it below. Your Application can only be processed with this signed declaration.

File Uploads:
Passport
*
Your Photo
Last School Report
Other file
Vaccination Certificate
*
Insurance Certificate
Signed Declaration (see above)
*