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Student Information
First name	Family name
Nationality	Male Female	Date of Birth

Home Address
City/Town	Country	Postal Code
Phone No.	Fax No.	First Language
Email

In case of emergency contact - Auckland area (if known)
Name	Phone	Fax
Name	Phone	Fax

Please tell us about yourself
Do you like pets?	No Yes
Do you like children?	No Yes
Do you smoke?	No Yes	If Yes, how much?
Please indicate your English level 0=no english / 6-advanced
0 1 2 3 4 5 6
Countries you have visited?		Any Medical or diet requirement?(due to,allergies,relirion,etc)

Reservations
Would you like Homestay? ($24/night, payable directly to your host family)	No Yes

If yes, please indicate	Long term(6,10,12 weeks) Short term(one month)
Name of programme in which are you registered
Programme dates for which you require accommodation
Would you like Airport welcome?	No Yes
If yes, please indicate
Arrival date Airline Flight # Arrival time

You pay a homestay placement fee directly to the SECS and a daily homestay rate directly to the host family.

Payment Method
Tuition and fees may be paid by bank draft or by T/T in New Zealand Funds, payable to

The Sheffield English Language School
A/C#
ASB Bank
Queen Street

Declaration of Applicant
I agree to comply with all rules and regulations of the Sheffield English Language School
present and future. If I plan to move out from my host family's home, I agree to tell the host family 2 week before the day I move. I agree to purchase adequate medical coverage during my stay in New Zealand.

To submit this application

Via fax:
Download the printable version of this form, fill it out in full, and fax it to us at 64-9-309-6002.

Via mail:
Download the printable version of this form, fill it out in full, making sure to include your cheque, or copy of T/T(telegraphic transfer) receipt plus photographs in the envelope, and mail it to:

Student Services
Sheffield English Language School
POBox 106417, Downtown
Auckland, New Zealand

a. A non-refundable homestay application fee is payable.

b. Homestay fees include breakfast and dinner on weekdays (Monday to Friday) and three meals at weekends.

c. You must let us know your flight arrival details at least two weeks before you arrive, so that we can arrange your homestay. Should you arrive with less than two weeks notice, we will help you find a standard hotel or backpacker accommodation until a homestay becomes available.

d. If you are going to be in homestay for more than 8 weeks, your initial homestay booking will be for a period of 8 weeks so that you and your homestay family have time to adjust to each other.

e. Homestay fees are paid two weeks in advance (fortnightly) to your homestay family.

f. You must give a minimum of 2 weeks notice if you wish to change from homestay to another form of accommodation.