Important!

All information is confidential and will be used for the purpose of student placement only!

For students under 18 years of age, please supply the full contact details of a parent or guardian (at the end of the form).

Course Finder

Complete this form as fully as possible to assist us in finding the course and school best suited to you. Fields marked * are required.

Personal Details (Student)

Given Name: *
Family Name: *
Address:*
Telephone (Home):*	(numbers only, no spaces)
Telephone (Office):	(numbers only, no spaces)
Mobile:	(numbers only, no spaces)
Email: *
Age:*
Gender:*
Educational Qualifications:

Course Information and Planning

Type of course : *
Location preference : *
Do you require a New Zealand guardian? (more information)	Yes No
Reasons for study (check any that apply) :	Better communication Enter university Enter school Social activity Improve employment prospects Other (please explain below):
When do you intend to study abroad?:	From: To:
Do you have any emergency contacts (family or friends) in your chosen area?. If so, please give details (name, address, contact telephone numbers etc):

Accomodation

I would like Proactive Study Abroad to arrange a homestay for me:	Yes No
If you answered Yes, please state your preference for your homestay family: *
Do you smoke?	Yes No
Do you prefer a non-smoking homestay?	Yes No

Medical and Insurance

Proactive Study Abroad recommends that all students have adequate travel, accident and illness insurance cover. We recommend Uni-Care Educational Insurance Ltd, N.Z.	Please send insurance quote I will arrange my own insurance
I have the following medical problems/allergies/dietary requirements:

Travel

Parent/Guardian Consent (FOR STUDENTS UNDER 18 YEARS OF AGE)

I would like Proactive Study Abroad to arrange my air travel	Yes No
Please give me a quotation for:	Business class Economy class
My first choice of airline is:
Would you like us to arrange car hire for you?	Yes No
Would you like the school to arrange transport from the airport? (There will an extra charge for this, payable to the school)	Yes No
Do you want to attend a country orientation and familiarisation class before you travel?	Yes No
Do you want to attend a language preparation class before you travel?	Yes No
Additional information: