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APPLICATION FORM - 2024 ENTRY
Applications are open for tamariki entering Year 9 in 2024 only
Date of Application
*
PART ONE: RANGATAHI INFORMATION
A. PARTICULARS OF RANGATAHI (STUDENT)
Student's name
*
First name
Last name
Gender
*
Female
Male
Student's home address
*
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Home phone
Mobile
Date of Birth
*
Country of Birth
*
Permanent Resident
*
No
Yes
Please provide Certified Signed Copy of Birth Certificate (see the checklist at end of form)
What school are you currently attending?
What year group are you currently in, in 2023?
Other
1. Year 7/Form 1
2. Year 8/Form 2
3. Year 9/Form 3
4. Year 10/Form 4
5. Year 11/Form 5
6. Year 12/Form 6
7. Year 13/Form 7
Alumni/Student Left
Current Principal/Head teacher we may contact (name, position, phone, email)
Please provide a copy of the latest School Report (see checklist at end of form)
Which school are you applying to for 2024?
*
Epsom Girls Grammar School
Auckland Grammar School
Please note - Applications are only being accepted for Year 9/Form 3 girls for Epsom Girls Grammar and Year 9/Form 3 boys for Auckland Grammar School.
What year will you be in 2024?
Year 9 / Form 3
Year 10 / Form 4
Year 11 / Form 5
Year 12 / Form 6
Year 13 / Form 7
MAORI/PACIFIC WHAKAPAPA:
Iwi, Motu or Island you identify with
*
Hapu you identify with
Maunga, mauga or mountain
Awa, moana, vaitafe or river, lake, sea
Waka, Canoe or Ship//Nu'u or Village you identify with
Ethnicity (Select one)
*
Australian
Bangladesh
Cambodian
Chinese
Cook Island Maori
Croatian
English
Fijian
Fijian Indian
Filipino
German
Indian
Irish
Japanese
Korean
Latin American
Maori
Middle Eastern
Niuean
NZ European
Other (please specify below)
Other Asian (please specify below)
Other European (please specify below)
Other Pacific Peoples (please specify below)
Pacifica general (Island not stated)
Samoan
Scottish
Tokelauan
Tongan
Other Ethnicities - You may select more than one
Australian
Bangladesh
Cambodian
Chinese
Cook Island Maori
Croatian
English
Fijian
Fijian Indian
Filipino
German
Indian
Irish
Japanese
Korean
Latin American
Maori
Middle Eastern
Niuean
NZ European
Other (please specify below)
Other Asian (please specify below)
Other European (please specify below)
Other Pacific Peoples (please specify below)
Pacifica general (Island not stated)
Samoan
Scottish
Tokelauan
Tongan
What is the religion of your whānau?
Do you practice your religion?
B. RANGATAHI INTERESTS AND ACHIEVEMENTS
Please provide information about your tamariki's;
Sporting Interests
Musical interests &/or activities
Other Activities ie Kapa haka, hobbies, personal and community interests. Please list everything your tamariki is involved in.
C. RANGATAHI HEALTH STATEMENT (This information is for use by the school and kainga)
Does your tamariki
Have a physical condition that might affect learning (eg glasses, hearing loss, impaired motor skills)? Please explain
Have any other health problems? Please explain
Require regular medications? Please explain
Suffer from ADHD, anxiety, depression or other? Please explain
Have any special dietary requirements? Please explain
Have any allergies? Please explain
All students should have completed their childhood Immunisation Programme before commencing secondary school. Has your tamariki had the following vaccinations?
Vaccinations general
Please provide copy of Immunisation Records (see checklist at end of form)
Has your tamariki ever had involvement with
Any other significant agency involvement (please explain below)
Health Camp
Nil
Oranga Tamariki
Other Counselling/Psychological Services
Police/Youth Aid
Specialist Education Services (incl RTLB, School Guidance, SENCO, SWIS etc)
If you ticked yes, please explain the nature of any involvement
Please provide any reports from agencies/professionals that have had/are having involvement with your tamariki (see checklist at end of form)
Is there anything else you would like to tells us about your child's health
D. RANGATAHI STATEMENT
We would like to get to know about your tamariki. On a separate A4 sheet please have your rangatahi tell us a bit about him/herself. This is to be completed in his/her own handwriting on a separate sheet and sent with all other required documents (see checklist at end of form)
E. Ministry of Education Boarding Allowance
Are you applying for MOE?
*
Ministry of Education Boarding Allowance (Multiple barriers or Access barriers)
PART TWO - PARENTS/GUARDIANS & WHANAU INFORMATION
A. PARTICULARS OF PARENTS/GUARDIANS WHO LIVE AT SAME ADDRESS AS RANGATAHI
Parent/Carer at same address
*
First name
Last name
Relationship with Student
*
Aunt
Brother
Father
Grandfather
Grandmother
Guardian
Half Brother
Half Sister
Mother
Other
Sister
Step Brother
Step Sister
Step-Father
Step-Mother
Uncle
Email address
*
Mobile
*
Other phone
Name of Employer & Occupation
How Parents/Carers can help InZone. Please choose one or more
*
In order to keep fees down, it is crucial we create a hub of volunteers amongst whanau working together with us. Please tick how you may be able to help out
Cooking
Fundraising
Kapa haka and/or cultural activities
Other
Supervision on field trips, sports activities or outings
Tutoring
Weekend staff relief
+ Add another
- Remove
B. PARTICULARS OF PARENTS/GUARDIANS WHO LIVE AT DIFFERENT ADDRESS TO RANGATAHI
Parent/Carer at different address
First name
Last name
Relationship with Student
Aunt
Brother
Father
Grandfather
Grandmother
Guardian
Half Brother
Half Sister
Mother
Other
Sister
Step Brother
Step Sister
Step-Father
Step-Mother
Uncle
Address
Email address
Mobile
Other phone
Name of Employer & Occupation
How Parents/Carers can help InZone. Please choose one or more
In order to keep fees down, it is crucial we create a hub of volunteers amongst whanau working together with us. Please tick how you may be able to help out
Cooking
Fundraising
Kapa haka and/or cultural activities
Other
Supervision on field trips, sports activities or outings
Tutoring
Weekend staff relief
Are there any current Parenting Orders or Child Custody Arrangements?
If Yes, please provide copies of any orders/arrangements (see checklist at end of form)
+ Add another
- Remove
C. SIBLINGS OF THE APPLICANT (Please include any whangai siblings or other dependent children not living with the applicant)
Brother/sister's name
First name
Last name
Gender
Female
Male
Date of Birth
+ Add another
- Remove
D. FINANCIAL INFORMATION OF PARENTS/GUARDIANS
Total Annual Household Income (salary/wages &/or any MSD payments) of the Parent/Guardian (& Spouse/Partner if applicable) BEFORE tax & any other deductions
*
1. Under $45,000
2. $45,000-$60,000
3. $60,000-$80,000
4. $80,000-$100,000
5. $100,000-$120,000
6. $120,000 or more
E. RESIDENCE OF THE PARENTS/GUARDIANS
What residence do you occupy?
*
Own Home
Renting
Boarding
Other
If you selected "other", please explain
How long have you lived at the above address (years & months)
How far is your residence from InZone (in kms)
F. PARENTS/GUARDIANS STATEMENT
As a parent/guardian, please list your reasons for wishing your tamariki to be a part of InZone. Please write on a separate sheet and send with all other required documents (see checklist at end of form). Also, if you wish to attach a more detailed statement in answer to some of the questions above, please do so here
G. PARENTS/GUARDIANS INVOLVEMENT WITH INZONE
Is there anyother way you would like to be involved in helping InZone?
H. PARENTS/GUARDIANS GENERAL
What is the highest level of education of
Mother
*
Father
*
Please tell us how you heard about us
*
Whānau
Friend
Advertisement
Internet
School
Other
If you selected "other" please explain
I. EMERGENCY DETAILS (Not Parents or Caregivers) -
Your emergency contact person must reside within a 30 kilometer radius of InZone AND must be available to care for the student in the event of an emergency
Name, Email, Phone & Address
*
Relationship to Applicant
*
PART THREE - DECLARATION AND PRIVACY ACT
DECLARATION - It is important that accurate information is given to ensure best practice in the care of the student. InZone reserves the right to reconsider rangatahi placement if details are inaccurate or incorrect or misleading information is provided.
I/we declare that the information provided in this application is true and correct.
I/we agree to notify InZone as soon as reasonably practicable of any change to the information contained in this application
I/we understand that acceptance of this form does not constitute admission of our tamariki to InZone and that selection of rangatahi for admission to InZone is at the discretion of InZone.
I/we understand should an offer be made that we will be required to enter into a written agreement with InZone
PRIVACY ACT - The information in this application form and collected by InZone during the application process and during the period in which the rangatahi is enrolled at InZone is intended for use in connection with assessing the suitability of the applicant (including sharing the application with Auckland Grammar School/Epsom Girls Grammar School as part of the application process) and the subsequent provision of boarding accommodation and wellbeing of the rangatahi during their time at InZone. InZone has as its primary purpose the provision of boarding accommodation, wellbeing and education of rangatahi and shall obtain such information as necessary to achieve this purpose and facilitate the operations and activities of InZone. The information collected may be used by any of the staff at InZone, consultants to InZone, existing and potential partners and services providers of InZone for these purposes.
I/we agree that InZone can obtain information about me/us from, and provide information about me/us to, other organisations or people it considers appropriate (including organisations that partner with InZone) for these purposes.
I/we understand and agree to the personal information provided in this form, and as collected above from other organisations, being used and disclosed for these purposes.
I/we agree that InZone may exchange information about me/us with credit reporting agencies on an ongoing basis. Those agencies may retain that information and provide it to other customers who use their credit reporting services.
I/we understand that I/we have the right to request access and request correction of any personal information.
I/we understand that InZone will follow the Information Privacy Principles in the Privacy Act 2020 relating to the collection, storage, use and disclosure of personal information.
CHECKLIST
Please note the following -
The address for all return mail will be the "rangatahi residential address"
The address given should be the student's usual home address. If the rangatahi spends lengthy periods at another address, then that address should be noted
Please check and tick that you have
Paid $25 administration fee (non-refundable) to our account no. 12-3198-0066948-000
Completed all details in the online application form
Please check and tick that you have sent to InZone the following documents:-
Certified copy of Birth Certificate
Latest School Report
Immunisation Records
Any Agency Reports
Rangatahi Statement (in his/her own handwriting)
Any Parenting orders/Caregiving arrangements
Parent/Guardian Statement
PLEASE NOTE INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED
All correspondence should be sent to:
info@inzoneeducation.org.nz
alternatively, you can post to
Admissions
InZone Education Foundation
99 Owens Road
Epsom, Auckland 1023
Please check the highlighted fields
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