Application Form Email - Avonmore Tertiary Institute
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1
2Personal Details
First name:
Last name:
Preferred name:
Title:
Ms
Miss
Mrs
Mr
Other
_ _/_ _ /_ _ _ _
Gender:
Male
Female
Birth Date:
Have you studied at Avonmore before?
Yes
No
If Yes, under what name:
If Yes, what was your student ID:
Academic Information
Last secondary school you attended:
Final year at school:
Name of course you wish to enrol in:
_ _/_ _ /_ _ _ _
Start date:
Campus you wish to attend:
Christchurch
Tauranga
Auckland (City )
Rotorua
Auckland (North Shore)
Home County Contact Details
Street address:
Suburb:
Town/City:
Postal code:
Mobile:
Email:
Land-line:
Passport Details
Student must bring their passport when they enrol.
Passport number:
Issuing country:
_ _/_ _ /_ _ _ _
Passprt expiry date:
Disability
Do you live with the effects of a long-term illness or disability?
Yes
No
If ‘yes’, please provide details:
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