campbell education form pdf...
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CampbellEducationNewZealandHighSchoolPathwayProgrammeApplicationFormforName:____________________________________
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Priortofillingoutthisform,ifyouhavenot,pleasebrieflyaccessCampbellEducationpage:www.campbell.ac.nz/campbell-educationDOCUMENTSUBMISSIONCHECKLISTHaveyouincludedthefollowing?
1. AnoriginalCampbellEducationapplicationformfilledoutinEnglish !
2. AphotocollageofyouwithyourfamilyorfriendsforyourhostfamilyonA4sizepaper(optional) !
3. Academicrecord/gradesforthepast2yearsissuedbyyourschoolinyourhome
country !
4. Referenceletterfromyourschoolorteacher !
5. AStatementofHealthformsignedbyamedicaldoctor !CampbellEducationadvisesapplicantstokeepacompleteduplicateoftheapplicationdocumentsfortheirrecords.ThankyouforpreparingtheaboveandwelookforwardtowelcomingyoutoNewZealandsoon.CampbellEducation
Ourcontactdetails: Emailaddress:[email protected]:http://www.campbell.ac.nz/campbell-educationPhone:+6448033434
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AGENTCOMPANYNAME
OFFICELOCATION
CONTACTNAME
CONTACTEMAIL
CONTACTPHONE
EMERGENCYPHONE/MOBILE
APPLICATIONFORM
NZHIGHSCHOOLPATHWAYPROGRAMMEApplicationsubmissiondate: _________________
PERSONALDETAILS
Firstname:________________________________ Familyname:____________________________________
Iliketobecalled:___________________________ Male!Female!
Dateofbirth:(d,m,y)_______________________ Ageuponarrival:_________________________________
Nativelanguage:___________________________ 2ndlanguagespoken:______________________________
PassportNo.(ifknown)______________________ Passportexpirydate:______________________________
PassportCountryofIssue____________________
HOMEADDRESS&CONTACTDETAILS(NOTAGENT)
Streetname&number: _______________________________________________________________________
City:_______________________ Country:_____________________ Postalcode:____________________
PhoneNo: ________________________________ MobilePhoneNo:________________________________
FamilyEmailAddress(tocontactparents): ________________________________________________________
YOURFAMILYDETAILS:(Pleaseincludeallimmediatefamilymembers)
Relationshiptoyou
Nameandage Occupation ContactPh(forparentsonly)
Liveswithyou?
Yes!No!
Yes!No!
Yes!No!
Yes!No!
Pleaseattach1passport-sizedphotographlessthan6monthsold(Electronicattachmentisok)
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Ifyoudonotlivewithbothyourparents,pleaseincludethecontactdetailsbelowfortheparentyoudonotnormallylivewith:
Name: _____________________ PhoneNo:_________________MobilePhoneNo:___________________
Fulladdress:_________________________________________________________________________________
EMERGENCYCONTACTPERSONOTHERTHANYOURPARENTS:
Name: ___________________________________ Relationshiptoyou: ______________________________
PhoneNo: ________________________________ MobilePhoneNo:________________________________
Fulladdress:_________________________________________________________________________________
YOURCURRENTSCHOOLINYOUROWNCOUNTRY:
Nameofpresenthighschool:_________________________________________________Yearlevel:________
Subjectsyoucurrentlystudy:___________________________________________________________________
PROGRAMMESELECTION
HighSchoolPreparationatTheCampbellInstitute
Duration ___weeks
PreferredStartDate
HighSchoolProgramme
Duration ___termsor___yearsor!untilgraduation
PreferredStartDate
PreferredSchool(s)
1.
2.
3.
SchoolsScotsCollege,SamuelMarsdenCollegiateSchool,WellingtonCollege(Boys),WellingtonGirls’College,HuttValleyHighSchool,OnslowCollegeTermDatesPleasecheckonthiswebsite:
http://nz.myschoolholidays.com/
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WHATSCHOOLYEARANDSUBJECTSDOYOUWISHTOTAKEATANZHIGHSCHOOL?
WhichofthefollowingYearsdoyouwishtoenter?
! Yr9(13-14y/o)! Yr10(14-15y/o)! Yr11(15-16y/o)! Yr12(16-17y/o)! Yr13(17-18y/o)
(Pleasecirclesubjectsyouwishtotakebelow)
Maths,English,Science,Biology,Physics,Chemistry,History,Geography,French,Japanese,Maori,
Art,Drama,Music,Photography,ComputerStudies,Graphics,Woodwork,Metalwork,
Foodtechnology(cooking),PhysicalEducation(PE),SocialStudies,Accounting
WhatsubjectotherthantheonesstatedabovewouldyouliketostudyinNZ? ___________________________
WhatisyourEnglishlevel(ifknown):Beginner,Pre-Intermediate,Intermediate,UpperIntermediate,Advanced
ADDITIONALPROGRAMMES
Nativelanguagesupport !No!Yes
Holidayboosterprogrammes !No!Yes
Seeprogrammebrochureformoredetailsaboutadditionalprogrammes.
FUTUREPLANS
Whatareyourfutureworkorstudyplansaftercompletinghighschool:
___________________________________________________________________________________________
___________________________________________________________________________________________
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YOURINTERESTSANDHOBBIES
Whatareyourhobbies?_______________________________________________________________________
Whatareyourinterests? ______________________________________________________________________
WhatafterschoolactivitiesdoyoucurrentlytakeorwishtotryinNZi.e.sports,musiclessonsetc:
Activity Currentlydoing? WishtocontinueinNZ? No.ofhoursperweek
Whatareyourfutureambitions?________________________________________________________________
Haveyoueverlivedawayfromyourfamily?No/Yes,howlongandwhere? ____________________________
YOURRELIGION:
Whattypeofreligion?______________________Howoftendoyouattendservices?_______permonth/year
Areyouwillingtolivewithafamilywithanotherreligion?Donotmind!Prefernot!
DuringtheprogrammeinNZ,whichreligiousserviceswouldyouliketoattend?
Myown!Myhostfamily’s(evenifdifferent)!Idonotwishtoattend!
ACCOMMODATIONINNZ:(Thisinformationwillhelpustochooseyourhostfamily)
FOOD:
Doyouhaveanyspecialdietaryrequirements?No/Yes.Ifyes,pleaseexplain:__________________________
___________________________________________________________________________________________
• FoodAllergies_________________________________________________________________________
• Vegetarian:No/Yes(pleasecirclefoodyoudoNOTeat)redmeat,chicken,fish,eggs,dairy
Ifyouareavegetarian,areyoupreparedtolivewithameat-eatingfamily?No/Yes
• Otherreasons:(pleasestatewhatfoodsyoucannoteat)______________________________________
PETANIMALS:
Doyouhaveallergiestoanimals?No/Yes:Whichones?____________________________________________
Areyouafraidofanyanimals?No/Yes:Whichones? ______________________________________________
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OTHERINFORMATION:
Doyousmoke?No/Yes:Howmanycigarettesperdaydoyousmoke? ________________________________
Areyouwillingtostop?No/Yes
Canyoulivewithsmokers?No/Yes/Preferablynot
TYPEOFNZFAMILY:(Preferencecannotbeguaranteed,butwe’lltryourbesttomatchyouwithafamily
accordingtoyourpreferences)
Familywithchildrenunder10yearsold: Prefer Donotmind Prefernot
Familywithchildrenover11yearsold: Prefer Donotmind Prefernot
Familywithpets: Prefer Donotmind Prefernot
YOUANDNEWZEALAND:
PleaselistbelowyourmainreasonsforselectingNZforyouroverseasstudyexperience:
___________________________________________________________________________________________
Whatdoyouwishtoachieveduringthisprogramme?
___________________________________________________________________________________________
___________________________________________________________________________________________
Pleaseexplainwhatyouwouldliketocontributetoyourhostfamily,school,schoolfriendsandthelocal
communityduringyourstayinNewZealand:
___________________________________________________________________________________________
___________________________________________________________________________________________
MEDICALINFORMATION
Areyoucurrentlyunderadoctor’scare?No/Yes:forwhatcondition?_________________________________
Doyoutakeanyprescriptionmedication?No/Yes:pleaselist?_______________________________________
WouldyourequireregularorcontinuousmedicalattentionduringtheNZprogramme?No/Yes:pleasegive
details:_____________________________________________________________________________________
DoyourequirespecialistdentalcarewhileinNZ?No/Yes:pleaseexplainandattachareportfrom
yourdentist. ________________________________________________________________________________
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STATEMENTOFHEALTH
SectionA:PersonalDetails(tobecompletedbythestudentandhis/herparents)
Student’sname: _____________________________________________________________________________
DateofBirth:________________ Gender:M!F!CountryofOrigin: _________________________
Height:___________________________________ Weight: ________________________________________
SectionB:MedicalHistory(tobecompletedbyamedicalphysician)
Hasthestudentsufferedfromanyofthefollowingconditions?Name No Yes* When Detailsandtreatmentrequired(comments)Allergies Asthma Hayfever
Hasthestudenteverhadanyofthefollowing?Name No Yes* When Name No Yes* WhenChickenPox Headache Depression Appendicitis Mentalillness Cough(persistent) HIVorAIDS DiabetesMellitus Malaria Enuresis ScarletFever Thyroidabnormality(Struma) Hepatitis Hernia PoliomyeticFever Learningorspeechdifficulty RheumaticFever Vertigo,Dizziness Parasites(intestinal) SeizureDisorder Sleepwalking Others *Wherethestudenthasansweredyestoanyoftheabovequestionsfulldetailsofanytreatmentand/ormedicationgivenshouldbeattachedbythephysician.Pleaseincludethedetailsofanyongoingtreatmentsormedicationrequired.
Isthestudentcurrentlyusinganyprescriptiondrugs/medication?No/Yes:Pleasegivedetails:
Hasthestudenteverbeenhospitalised?No/Yes:Whenandwhy?
Hasthestudenteverbeenadvisedtohavesurgery?No/Yes:Forwhat?
Hasstudenteverconsultedaneurologist,psychologistoranyotherspecialistinnervousormentaldisorder?No/Yes:Pleasegivedetails:
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Anydisease,impairmentorabnormalityofanyofthefollowing(ifansweringYestoanyofthebelow,pleasegivefurtherdetails):Papillaryandkneereflexes:No/Yes:Pleasegivedetails:____________________________________________Abnormalorgans,digestivesystem:No/Yes:_____________________________________________________Bones,joint,locomotorsystem:No/Yes: ________________________________________________________Blood,endocrinesystem:No/Yes: _____________________________________________________________EarsorHearing:No/Yes:_____________________________________________________________________Eatingdisorder:No/Yes: _____________________________________________________________________Emotional,behaviouralproblems:No/Yes: ______________________________________________________Eyesorvision:No/Yes: ______________________________________________________________________Genito-urinarysystem:No/Yes: _______________________________________________________________HeartorBloodVessels:No/Yes:_______________________________________________________________Lungs,Respiratorysystem:No/Yes: ____________________________________________________________Skin(Acne,etc.):No/Yes: ____________________________________________________________________Tonsils,noseorthroat:No/Yes: _______________________________________________________________Varicoseveins:No/Yes:______________________________________________________________________Arethereanyrestrictionsonthestudent’sparticipationinphysicaleducationandorsportsactivities?No/Yes: ___________________________________________________________________________________
ImmunisationRecordPleasestatethedateofeachimmunisation(ordateofillness)given.Inthecaseofmultipledosesrequiredgivethedateofthelastdosegiven:Vaccine Dategiven Complete? Vaccine Dategiven Complete?HepatitisB BCG
DTPH MeningitisB
Polio Diphtheria
Measles Tetanus
Mumps
Rubella
Pleaseselect:❏Theapplicantappearsbothphysicallyandmentallysuitableforaculturalexchangeprogramme❏Ihavesomeconcernsabouttheapplicant’ssuitabilityandhaveattachedareportoutliningmyconcerns❏IdonotrecommendtheapplicantforthisprogrammeandhaveattachedareportoutliningmyconcernsI,_______________________theundersigned,havegivenathoroughphysicalexaminationandreviewedthemedicalhistoryofthecandidate.Icertifythatallrelevantmedicalinformationhasbeenincluded,andthattheaboveinformationiscompletedandaccuratetothebestofmyknowledge.Physician’sname: __________________________ Physician’sSignature:_____________________________
Date:
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TermsandConditionsofstudyatTheCampbellInstitute
TheCampbellInstitutehasagreedtoobserveandbeboundbyTheEducation(PastoralCareforInternationalStudents)CodeofPractice2016.CopiesoftheCodeareavailableonrequestfromthisinstitutionorfromtheNewZealandQualificationsAuthoritywebsite:www.nzqa.govt.nz
ACCEPTANCEOFTERMSANDCONDITIONS
Onpaymentoffees,thetermsandconditionswillbedeemedtohavebeenacceptedinfull,whetherornotthisformhasbeensignedbythestudent.
COURSES
1.1 TheGeneralEnglish,IELTSandHighSchoolPreparationcoursestartdatesareanyMonday(or,ifMondayisapublicholiday,thenextbusinessday).Forstartdatesofothercourses,pleaserefertoTheCampbellInstitutewebsite:www.campbell.ac.nz
1.2 TheCampbellInstitutereservestherighttochangecoursearrangementswithoutpriornotice.1.3 StudentplacementinanycourseissubjecttoEnglishlanguageproficiency,whichwillbetesteduponarrival.1.4 AttheendoftheircoursestudentswillreceiveaCertificateofCourseCompletion.Thisissubjecttothestudents’attendancerate,
andstudentswithanattendancelowerthan90%maynotreceiveacertificate.
PAYMENTOFFEES
2.1 Courserelatedfeesmustbepaidinfull,priortothecommencementofthecoursethatthestudentisenrolledin.2.2 Allcourserelatedfeesarecalculatedincompleteweeksandnodiscountisgivenforweekswhichincludepublicholidaysorpart
weeks.2.3 TheCampbellInstitutecomplieswithNZQArequirementstoprotectstudentfees.
CANCELLATIONANDREFUNDS
3.1 CancellationofclassbyTheCampbellInstitute:CancellationorCourseReductionbeforetheendoftheeighthcourseday:TheCampbellInstitutewillrefundalltuitionfeesandwillalsorefundanyunusedportionofaccommodationfees,takingrequirednoticeperiodsintoaccount.AccommodationPlacementFeeisnonrefundable.CancellationorCourseReductionaftertheendoftheeighthcourseday:TheCampbellInstitutewillrefundanyunusedportionoftuitionfees–prorata–minusanynonrefundableportionoffeessuchasadministrationorplacementfees.
3.2 ForceMajeureTheCampbellInstituteisnotliableforfailuretoperformitsobligationsifsuchfailureisasaresultofActsofGodthatarebeyondthereasonablecontroloftheparties(including,butnotlimitedto:fire,flood,earthquake,storm,hurricane,infectiousdiseasesorpandemics,lossofelectricity,internetortelephoneservice).IfTheCampbellInstitutesitesForceMajeureasanexcuseforfailuretoperformitsobligations,thenitmustprovethatittookreasonablestepstominimisedelayordamagescausedbyforeseeableevents,thattheschoolsubstantiallyfulfilledallnon-excusedobligations,andthattheotherparty(student,agent,etc.)was,wherepossible,notifiedofthelikelihoodoractualoccurrenceoftheevent.
3.3 Withdrawalbyastudent:Oncethecoursehasstarted:Forenrolmentsofuptofiveweeks:Ifthestudentwithdrawswithinthefirsttwodaysofthecourse,TheCampbellInstitutewillrefund50%oftheunusedweeklytuitionfees.Forcoursesbetween5and12weeksinclusive:Withdrawalbyastudentatanytimeupuntiltheendofthefifthworkingdayofthecoursewillresultinarefundof75%oftotalcourse-relatedfeespaid.Withdrawalfromacourseaftertheendofthefifthdaywillnotresultinanyrefund.Forcoursesof3monthsandgreater:Withdrawalbyastudentatanytimeupuntiltheendofthetenthdayofthecoursewillresultinafullrefundoftuitionfeesminusnomorethan25%ofcourserelatedfeespaid.Withdrawalfromacourseaftertheendofthetenthdayofthecoursewillnotresultinanyrefund.
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3.4 Aftertheabovewithdrawaldeadlines,TheCampbellInstitutewillnotrefundanyfeesexceptforunusedhomestayfees.3.5 TheEnrolmentFee,MaterialsFeeandAccommodationPlacementfeearenon-refundable.3.6 Wedonotrefundfeesorgiveafreeextensionofthecourseifthestudent:
• ArriveslaterthanthecoursestartdatewithoutnotifyingTheCampbellInstitute• Takestimeoffduringthecourse(excludingapprovedholidays)• Leavesbeforethecourseenddate
3.7 Underthefollowingcircumstances,refundsaregivenatthediscretionoftheDirector,takingintoaccountthecircumstancesandanycostsalreadyincurredbytheschool;
• Thesignatoryceasingtoprovideacourseofeducationalinstructionascontractedwithastudent,whetheritstopsofitsownaccordorasrequiredbyaneducationqualityassuranceagency
• Thesignatoryceasingtobeasignatory• Thesignatoryceasingtobeaprovider
Ifdirectedbythestudent,thecodeadministratorortheagencyresponsibleforfeeprotectionmechanisms,TheCampbellInstituteagreestotransfertheamounttoanothersignatoryasagreedwiththestudent(orthestudent’sparentorlegalguardian).Inthecasewhereastudentisunabletotakeuptheirenrolmentduetoadeclinedvisaapplication,andthatthestudenthasalreadypaidtheirfees,Campbellwillprovideafullrefund,excluding:
• Administration/EnrolmentFee• Fullrefundofaccommodationfees,aslongasnoticeofthevisadeclineisprovidedtoCampbellatleast1weekpriorto
startdate.Otherwise,theplacementfeemaynotberefundedandthestudentwillneedtoprovide1weekofnoticetothehomestay
• AnyotherdirectcostsincurredbyCampbellasaresultoftheenrolmentThisrefundwillbeprocessedafterreceivingtheletterissuedbyImmigrationNewZealand,explainingthereasonforthevisadecline.StudentsmustsignthePublicTrustrefundformprovidedbyTheCampbellInstituteinorderfortherefundtobeconsideredforapproval.
3.8 StudentsenrolledinprivatetuitionmustnotifyTheCampbellInstituteatleast24hoursinadvancetocancelalesson,otherwisethereisnoentitlementforarefundoroptiontorescheduletheclasswithoutfurtherpayment.
3.9 TheCampbellInstitutewillnotifyImmigrationNewZealandofstudentswhowithdrawfromtheircourse.
HOLIDAYDURINGCOURSES
4.1 Studentsmaytakeamaximumofoneweek’sholidayforeach12weeksofstudywithoutlossoftuition,subjecttovisaconditions.TheCampbellInstitutewillnotgiverefundsorcourseextensionsforholidaysoverthisallowance.
4.2 Studentsmustgiveatleastoneweek’snoticeoftheholidayrequest.Ifnot,TheCampbellInstitutemaynotgranttherequestandthestudentwillloseanyrelatedtuitionfees.
ACCOMMODATION5.1 StudentsinanyformofTheCampbellInstituteaccommodationMUSTobeyTheCampbellInstituteAccommodationCodeof
Conduct.Ifyoubreachthiscode,youmayneedtoleaveyouraccommodationimmediately.5.2 AccommodationarrangedbyTheCampbellInstituteisonlyavailablefortheperiodofstudyatTheCampbellInstitute.5.3 Aweekofaccommodationissevendaysandsevennights;ratesforadditionaldayswillbequotedontheinvoice.5.4 Forenrolmentsrequiringhomestayorstudentresidenceaccommodation,TheCampbellInstituterequiresbookingandpaymentto
bemadewithaminimumof2weeks’notice.HomestayinformationwillnotbereleasedtoanagentorstudentuntilfullfeeshavebeenreceivedbyTheCampbellInstitute.
5.5 Failuretopayhomestayfeesinadvancemayresultinalossofhomestaybooking.5.6 IfthestudentleavesTheCampbellInstitutehomestayearly,boththehostfamilyandTheCampbellInstitutemustreceiveone
week’snoticeofthestudent’sintentiontoleave.TheCampbellInstitutewillrefundthebalanceofanyremainingpre-paidhomestayfees,minusanycostsrecoverablebyTheCampbellInstitute.
5.7 AllTheCampbellInstitutestudentaccommodationiscarefullyselectedandmonitoredbyTheCampbellInstitutestaff,inaccordancewiththeprovisionssetoutinTheEducation(PastoralCareforInternationalStudents)CodeofPractice2016.
5.8 TheCampbellInstitutereservestherighttopolicevetandvisitthecaregiverofastudentunder18yearsold.5.9 Studentsmustpayfortheirinternationaltelephonecallsinhomestayaccommodation.5.10 Ifthestudentisunhappywiththeirfirsthomestayallocation,thestudentmaychangetoanewhomestayonceonly,atthestudent’s
request.Morethanonechangewillincuranadditionalaccommodationplacementfee.5.11 StudentswillinformTheCampbellInstituteaboutanychangeofresidencethroughouttheirenrolment.
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ATTENDANCEANDBEHAVIOUR6.1 StudentsagreetobehaveconsideratelyandfollowallrulesandregulationsasoutlinedintheStudentHandbook,andchangesthat
aremadetothemfromtimetotime.Ifastudentdoesnotcomplywithalltherulesandregulations,thismayleadtoawarning,orinseriouscases,expulsion(terminationofenrolment).
6.2 AllstudentsallowTheCampbellInstitutepermissiontocontactparents,guardiansandagentsregardinganymatterofconcernsuchasacademicperformance,attendanceandphysical/mentalhealthissues.
6.3 Studentsarerequiredtoattendallprogrammedtuitionhoursandarriveatclassontime.
LIABILITYANDINSURANCE
7.1 Eachstudentmusthaveadequatemedicalandtravelinsurance.7.2 Studentsmustprovideevidenceofappropriateandcurrentmedicalandtravelinsuranceonenrolment.Thisinsurancemustcover
thefulllengthoftimespentinNewZealandandmustbecompliantwiththeinsurancerequirementsofTheEducation(PastoralCareforInternationalStudents)CodeofPractice2016,whichstatesthatstudentsenrollinginaninstitutionmusthaveappropriateinsurancecovering:1. thestudent’stravel—
a. toandfromNewZealand;b. withinNewZealand;andc. ifthetravelispartofthecourse,outsideNewZealand;and
2. medicalcareinNewZealand,includingdiagnosis,prescription,surgery,andhospitalisation;and3. repatriationorexpatriationofthestudentasaresultofseriousillnessorinjury,includingcoveroftravelcostsincurredby
familymembersassistingrepatriationorexpatriation;and4. deathofthestudent,includingcoverof—
a. travelcostsoffamilymemberstoandfromNewZealand;andb. costsofrepatriationorexpatriationofthebody;andc. funeralexpenses.
7.3 Failuretoprovideoracquireappropriateinsurancecoverwithinanappropriateamountoftimewillresultinterminationofenrolment.
7.4 TheCampbellInstitutewillnotbeheldresponsibleforanydamageorlossincurred(includinglossoffees)asaresultofanysickness,injuryoraccident.
7.5 TheCampbellInstituterequiresthewrittenconfirmationfromtheparentorlegalguardianoutliningplansafterenrolmentatTheCampbellInstitutehasfinishedandwrittenagreementtoanymajordecisionsorchanges,ofanyinternationalstudentunder18yearsold.
7.6 FailuretodiscloseanymedicalconditionsontheEnrolmentformmayresultinterminationofenrolment.
IMMIGRATIONREQUIREMENTS
8.1 TheCampbellInstitutewilltakeandkeepaphotocopyofastudent’spassportandcurrentvisathroughtheirenrolment.8.2 Studentsmustcomplywiththeconditionsofhis/hervisatostayinNewZealand.Forimmigrationinformation,pleasecontactthe
nearestImmigrationNZoffice,orvisitthewebsite:www.immigration.govt.nzUSEOFSTUDENTIMAGES9.1 Allstudents(orparents/guardiansforstudentsunder18)grantTheCampbellInstitute,itslicensees,agentsandsuccessorstheright
tousethestudent’simageorvoiceforpromotionofTheCampbellInstitute,including,butnotlimitedtodigitalvideo,socialmedia,brochuresandadvertisements.
IagreethattheinformationIhavegiventoTheCampbellInstituteistrueandcorrect.IhavereadandIaccepttheTermsandConditionsofEnrolment.StudentSignature:_____________________________________Date:_________________________________