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APPLICATION FORM

  • Please fill out the form and push the send button, or
  • Alternatively download the application form (click on the link below), fill it out and send it to us by Fax or email with the file attached. 
  • FAX: +64 (0)7 867 1175  Email: info@evakona.co.nz

DOWNLOAD APPLICATION FORM (PDF) / 117kb
       (you need to have Adobe Reader installed on your PC to be able to read this file)

Please read first our GENERAL CONDITIONS and HOW TO ENROL

 PERSONAL DETAILS
         
Family Name   Given Name (s)
Gender male
female		   Date of birth (d/m/y)
Street   Town/City
Postal Code/ZIP   Country
Phone   Fax
Email   Nationality
Passport No.   Occupation
Level of English good average poor none not sure
   
COURSES  
   
Course name

If you are applying for the General English Course, please indicate which one:  

Part time      Full time 21      Full time 23  

If you would like to join the Friday afternoon activity please tick: yes no
Starting date   Length of study (weeks)
   
 ARRIVAL/DEPARTURE  
 
Do you require our Meet & Greet service at Auckland airport? yes no
Arrival Date   Arrival time
Arrival from   Flight No.
Departure Date   Departure time
Destination   Flight No.
Do you require transport from Auckland to Whitianga?          yes no
Do you require transport from Whitianga to Auckland?          yes no
   
 ACCOMMODATION  
 
I would like information about a host family
I would like information about:
I will arrange my own accommodation
Please indicate the below only if you would like to stay with a host family:
Would you like to stay in a family with children?    yes no doesn't matter
Would you like to stay in a family with pets?         yes no doesn't matter
Do you smoke? yes no
Is there any food you cannot eat? no yes  
Do you have any health problems or allergies your host family should be informed about? no yes  
Please list your hobbies here:
   
 DECLARATION  
 

I have read and accepted the GENERAL CONDITIONS of Evakona education

(A Parent or Legal Guardian must sign for a student under the age of 18 years and complete the contact information field below.)

Student: please type:
I ACCEPT		   Date
Legal Guardian's Name:   Date

Legal Guardian’s Full Contact: (Address, Phone Number, Email)

 

By clicking the "Send"-button you accept our general conditions.
 Please print out the page before you send it, if you would like to keep a copy of the application form.
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