Application for Enrolment - International

Please read the instructions below carefully before you complete this enrolment form


    The purpose of this form is to obtain from you the information we need to assess you for admission into a course/qualification at Imperial. Please fill in the form properly by:

  • Completing all sections of the form.
  • Typing your answer in English correctly in the required boxes, and/or choosing your answers from multi-choice boxes.
  • Reading the Student Handbook and then signing the form.
  • Attaching to the form additional documentation that we require from you
Please fill in the details below.

* = required

The Course You Wish To Enrol In

Start Date And Corse Period

Personal Details


Phone *
(Please enter either phone numbe.)

Emergency Contact Details

English Level

IELTS Score (if appeared)

Academic And Vocational Information

Details of any accompanying dependents


Employment Details

Accommodation / Airport Pick-up

Health and Insurance

You are required to have appropriate Travel/Medical Insurance for the duration of your course. You will be invoiced for this unless you can provide an English version of your own insurance.

Information to support your Application

By Law students are required to have current travel and medical insurance covering the period of study until the expiry of Student Visa. ICNZ can advise about policies available. You need to provide evidence of valid insurance before enrolment.

Education Agent Details

Documents to be attached with the Application for Enrolment

Completed Application along with supporting documents can be mailed, emailed, faxed or hand delivered to our admission officer.
(Attach certified translated copy of documents not in English)

  • Passport bio-data pages of all applicants
  • Insurance documentation in English, if applicable
  • Medical condition, if any
  • IELTS Results
  • Evidence of highest qualifications
  • Related work experience, if any
  • Agent’s initial interview checklist, if applicable

Student Declaration

Please make sure that you read: the Student Handbook

Imperial College of New Zealand has agreed to observe and be bound by the Code of Practice for the Pastoral Care of International Students. Copies of the Code are available from the NZQA website


ICNZ collects and stores information from this form to comply with the requirements of/and where applicable:

  • the Ministry of Education (student statistical returns),
  • New Zealand Qualifications Authority (Record of Learning registration and Unit Standard outcomes),
  • Tertiary Education Commission (funding returns),
  • Industry Training Organisations (funding and academic outcomes),
  • Ministry of Social Development (confirmation of enrolment and academic outcomes),
  • Inland Revenue Department (student loan interest rebate),
  • Department of Immigration (if you are not a New Zealand citizen or permanent resident) and
  • Agencies who support particular students through scholarships and prizes, payment of fees or other awards (if you are a recipient of one of these awards).

The information is also used to select students for qualifications, to manage internal administrative processes, and for internal reporting.
Information about students may be supplied to, and sought from, other educational organisations for the purpose of verifying academic records.
In addition, when required by statute, the College releases information to Government agencies such as the New Zealand Police, Department of Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC).
In signing this enrolment form you authorise such disclosure on the understanding that the Organisation will observe the general conditions governing the release of information, as set out in the Privacy Act 1993 and the Post-compulsory Unique Identifier Code of Practice.
You may see any information held about you and amend any errors in that information. To do so, contact the Admissions Officer.
NB: The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires the Organisation to collect, hold, handle, use and disclose personal information in accordance with the twelve information privacy principlesin the Act.


In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery. The Organisation’s policy on withdrawal and refund of fees may be obtained from the Admissions Officer.


In signing this enrolment form you undertake to comply with the published rules and policies of the Organisation with regard to attendance, academic progress, standard of dress, health and safety, and behaviour.