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Application Form - ACG Parnell College

Application Selection

Proposed date of entry (*) Invalid Input If other, please specify
Please indicate the proposed entry level you wish to attend
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Student Information

Family Name (*)
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 Given Name/s (*)
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Preferred Name
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 Date of Birth (*)
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Country of Birth
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 Country of Citizenship (Passport)
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Gender (*)
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 First Language
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Ethnicity
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Student Mobile Phone
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Present School
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 Present Class / Year Level
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Family Information

Custodial Parents
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During the School week the Student lives with
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Relationship to Student
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 Relationship to Student
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 Relationship to Student If NOT living with student
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Title
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 Title
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 Title
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Family Name
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 Family Name
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 Family Name
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Given Name/s
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 Given Name/s
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 Given Name/s
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Home Address
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 Home Address
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 Home Address
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Suburb
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 Suburb
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 Suburb
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City
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 City
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 City
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Post Code
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 Post Code
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 Post Code
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Country
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 Country
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 Country
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Please complete at least one of the contact fields below
Home Phone
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 Home Phone
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 Home Phone
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Mobile Phone
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 Mobile Phone
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 Mobile Phone
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Business Phone
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 Business Phone
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 Business Phone
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Email
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 Email
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 Email
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Who would you prefer us to contact and by which method? (*)

Person Responsible for Fees

You do not need to complete this section if the information is the same as the parent/guardian

Relationship to Student
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Title
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Family Name
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Given Name/s
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Home Address
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Suburb
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City
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Post Code
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Country
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Home Phone
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Mobile Phone
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Business Phone
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Email
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How did you hear about ACG Parnell College?

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Academic Colleges Group
Level 17, ACG House, 396 Queen Street, Auckland
PO Box 6199, Wellesley Street, Auckland 1141, New Zealand
Phone: 64 9 306 0440. Fax: 64 9 307 5393 : Email: acg@acgedu.com
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