Application For Admission

STUDENT INFORMATION

Surname(Required)

First Name(Required)

Middle Name(s)

Known as

Date of Birth

Religious denomination

Nationality

Ethnicity

Iwi (if applicable)

Current School or Preschool attending

Proposed Year Level entering Wellesley

Proposed Year of Entry

PARENTS/GUARDIANS INFORMATION

Father

Stepfather

Caregiver

Guardian

Surname

First Name

Known as

Title

Postal Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Residential Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Ph Number

Mobile Ph Number(Required)

Business Ph

Email Address(Required)

Occupation

Place of Employment

PARENTS/GUARDIANS INFORMATION

Mother

Stepmother

Caregiver

Guardian

Surname

First Name

Known as

Title

Postal Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Residential Address

Street Address City State / Province / Region ZIP / Postal Code Country

Home Ph Number

Mobile Ph Number(Required)

Business Ph

Email Address(Required)

Occupation

Place of Employment

ALTERNATE CONTACTS (we may use this information should the contact information supplied become out of date)

Contact Name

Relationship

Contact Ph numbers(Required)

APPLICANT’S FAMILY ASSOCIATION WITH WELLESLEY COLLEGE

Names of brother(s) currently at Wellesley

Names of brother(s) previously at Wellesley

Dates attended

Other Sibling(s) Name

Date of birth

School or pre school attending

Is the applicants father an old boy?

Yes

No

Dates he started

Are any of his Grandfather(s) an Old Boy?

Yes

No

Name

Relationship

Date(s) of attendance

Are any other relatives Old Boys?

Yes

No

Name

Relationship

Date(s) of attendance

Privacy Act: The information on this form is held by Wellesley College to allow the College to carry out its functions as an education provider, including for use in connection with the application for admission, administration and promotion of the school and maintaining school records (of past, present and future students) The information may be disclosed to education, health and other specified agencies pursuant to the privacy Act 2020.

I hereby apply to have my son admitted to Wellesley College(Required)

I hereby apply to have my son admitted to Wellesley College

A non refundable application fee of $100.00 (GST inclusive) is payable upon application for admission. This is an application fee only and does not obligate Wellesley College to accept my son.

Internet Banking: Wellesley College, ANZ 060501 0826230 00 Please use your surname as a reference

I agree to notify Wellesley of any change in the information contained in this application form as soon is reasonable practicable.(Required)

I agree to notify Wellesley of any change in the information contained in this application form as soon is reasonable practicable.

Signed (Parent/Caregiver/Guardian)(Required)

Date

Full Name

Signed (Parent/Caregiver/Guardian)(Required)

Date

Full Name

Please enclose with this application

A copy of my son’s birth certificate

Max. file size: 100 MB.

A copy of my son’s most recent school report

Max. file size: 100 MB.

A copy of my son’s most recent PAT or e-asttle assessment results, if currently in class years 4 – 7

Max. file size: 100 MB.

The non-refundable Application Fee

Max. file size: 100 MB.

Evidence of my son’s NZ residency (where applicable)

Max. file size: 100 MB.

A copy of Specialist Reports (where applicable)

Max. file size: 100 MB.

A copy of Immunisation Certificate

Max. file size: 100 MB.

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