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Published by Repro Graphics, 2018-05-30 02:27:55

EIT International Application Form 2018

EIT International Application Form 2018


Thank you for choosing to study at EIT New Zealand. Please complete ALL sections of this application form
in BLOCK CAPITALS. You can also apply online at
Please return this completed application form with attached certificates and documentation by email
to [email protected].

APPLICANT DETAILS Date of birth //
Title Mr Mrs Miss Ms Other
Family name Age (Years) (Months)
First name(s)
Preferred name Male Female
Country of citizenship
Home address Married Single Partner

Passport number

City Postcode Agent stamp or mailing address
Phone number
Email address

Email Phone
Agent’s address

STUDY PLAN (Please complete the Mainstream Academic Programme details below)
Mainstream Academic Programme (Please complete the English Language Programme details below)
English Language Programme
Both of the above


Programme of choice

Intended start date (see programme details) Year

Campus Napier Gisborne Auckland


English Language Training (General English) IELTS Preparation (Napier only)

Intended start date Intended start date

New Zealand Certificate in English Language (NZCEL) General

Intended start date Academic

Eastern Institute of Technology | | ESSENTIAL INFORMATION

LANGUAGE QUALIFICATIONS Yes (please attach copy of certificate) No

Have you taken an English Test within the last two years?

(E.g. IELTS, TOEFL, or PTE) Please see the EIT website


Please list your academic certificates in date order with the subjects studied and the grades achieved. Please ensure that copies
of your certificates and academic transcripts are provided with your application, including official translations if not in English.

Educational Qualification Level (e.g. High School English Grade Dates (mm/yy)
Certificate, IB, BA, MSc)

Do you wish to apply for academic credit for previous tertiary study undertaken? Yes No

(If yes, please provide details)

ACCOMMODATION No Apartments on York
Do you wish to have accommodation arranged by EIT? Yes (Napier only)
If yes, please choose one of the following options Homestay Student Village

Minimum one semester
(Napier only)


Do you live with, or have experienced, any learning disability?

Hearing impairment Specific learning disability Medical (i.e. chronic pain) Neurological
Mobility Psychological Vision impairment

Temporary impairment – please state

Emergency contact name Relationship to you
Emergency contact phone Email


1. I hereby declare that the information I have given on this form is true and correct; no information For you to check and include with your application.
that could have a material bearing on any enrolment has been withheld. 2. I understand that this is
my application form and my enrolment will be completed when I arrive at EIT. 3. I understand that EIT Application form signed and dated by the applicant
reserves the right to terminate an offer of place if the information given in this application is incorrect Verified copies of academic transcripts
in any significant way. 4. I understand that the making of a false declaration is an offence under the and certificates, translated into English
Crimes Act 1961. 5. I hereby authorise EIT to release academic records or information related to my Photocopy of passport or birth certificate
health and safety to my parents, educational placement agency, guardian, other providers Proof of name change (if applicable)
of international education, the Police, Department of Courts, Immigration, NZQA or insurance agent, Evidence of English language proficiency
should EIT consider it is necessary to do so. 6. I have read and fully understand EIT’s International
Student Refund Policy, which is published on the EIT website. 7. I have fully considered and decided HOW DID YOU HEAR ABOUT US?
on the mainstream academic programme chosen in this application. 8. I agree to provide EIT with
evidence of an appropriate visa, travel and medical insurance for the duration of my qualification Educational agency
at EIT. I acknowledge that, if at any time I do not have a valid visa or insurance, then my enrolment Family/friends
at EIT will be cancelled. 9. I have read, understand and agree to the terms as listed above. Teachers/careers counsellor/NZ secondary school
Education fair
Student’s name NZ Embassy/NZ Education Centre
Newspaper advertising
Student’s signature Internet – please state website:


Other – please state:

ESSENTIAL INFORMATION | | Eastern Institute of Technology

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