Verification
(Office use
only)
FORM E2 INTERNATIONAL STUDENT
ACCOMMODATION APPLICATION
You are required to answer all questions truthfully and to the best of your knowledge.
False answers may result in the student’s enrolment being rejected or terminated. If the
student’s enrolment is terminated due to false information, the applicant will NOT be
entitled to a refund of any fees paid.
Name of Student: _____________________________________________
(Family Name)
(First Name)
Coromandel Area School is a signatory to the New Zealand Ministry of Education
Code of Practice for the Pastoral Care of International Students (2010). You may
download a Summary of this Code from the International Student pages on our
website (www.coroarea.school.nz ) or from the Ministry of Education. All student
accommodation will be assessed for compliance with the Code.
Three types of accommodation are available to International Students:
 Staying with parents
 Staying with a relative or close friend (“Designated Caregiver”)
 Staying in a Home Stay.
How to apply for student accommodation:
1) Please review the information about the types of accommodation provided in the
document “INTERNATIONAL STUDENT PROGRAM ACCOMMODATION
INFORMATION (FORM E15)”
2) Select the type of accommodation.
3) Fill out the appropriate sections of this form.
4) Upon acceptance into Coromandel Area School’s International Students
Program, the school will complete the accommodation assessment process for
students staying with Parents and students staying with Designated Caregivers.
Students choosing Home Stay Accommodation will be matched with a Home
Stay Caregiver and sent information about their accommodation.
Will the student (named above) be living with a parent?
Yes
No
If Yes -
Form E2 International Student Accommodation Application
1
Parent
passport
verified and
photocopied
Details of the Parent the International Student (named above) will reside with while
attending Coromandel Area School.
Proof of
residential
details
Name of Parent: ______________________________________________
(Please Print Full Name)
New Zealand Address: ___________________________________________________
______________________________________________________________________
Phone:(0_) _________________
Mobile Phone: _____________________
If No – Will the student be living with a relative or close family friend?
Yes
No
Details of the relative or close family friend the International Student (named above)
will reside with while attending Coromandel Area School.
Check the
designated
caregivers
status period
of study
Name of Caregiver/s: ______________________________________________
Address: ________________________________________________________
DC12
Indemnity
Document
________________________________________________________________
Phone: (0_) _________________
Mobile Phone: _____________________
Relationship to student ____________________________________
PLEASE FILL OUT AND ATTACH THE FORM DC12 “INDEMNITY
DOCUMENT FOR STUDENTS LIVING WITH A DESIGNATED
CAREGIVER”. Designated Caregivers will be assessed by Coromandel Area
School to ensure they meet Code requirements.
Home stay families
If the student does not plan to stay with a parent, relative or close family
friend, Coromandel Area School will arrange Home Stay Accommodation for
the student.
Home Stay Accommodation is a room, which may be shared with another
student, in a home with a New Zealand family. The Home Stay family may
have children the student’s own age or may host other International Students,
so your child may have companionship.
Home Stay Accommodation gives a student a chance to experience family life in
New Zealand and to practice their English on a daily basis. Home Stay
families have requested to host international students and enjoy learning
about other cultures. Lasting friendships often develop from Home Stays.
Form E2 International Student Accommodation Application
2
You will pay a Home Stay Accommodation Fee to Coromandel Area School to
cover the costs of the accommodation. Coromandel Area School then pays the
Home Stay Family the fee on your behalf.
Home Stay Accommodation includes:



Bedroom with a table or desk, chair, mirror, reading lamp, bed with linen
and blankets or duvet, heating system, chest of drawers and/or wardrobe.
Meals - 3 meals a day and snacks, including a packed lunch during the
school week.
Laundry – washing. Students over age 14 are responsible for their own
ironing.
Student Behaviour:
Home Stay families expect the same standard of behaviour as would be expected from
their own children of a similar age, but make allowances for cultural differences.
Changing Home Stays:
Students must give at least two weeks notice or two weeks board in lieu of notice.
Students may never change Home Stays without the knowledge of the school. If a
student is to be moved, the Home Stay and the parents will be advised of the reason
why.
To help ensure that there is a good match between the International Student and the
Home Stay Family, please tell us a little bit more about the student:
Student’s gender (circle one):
Male
Female
Student’s age: ________________________
Sports the student enjoys? ____________________________________________
___________________________________________________________________
Hobbies and special interests? ___________________________________________
Favourite types of music? _____________________________________________
Play any musical instrument? What? _____________________________________
Food allergies or special diets (e.g., vegetarian)_____________________________
How friendly and outgoing is the student? (Please circle one)
Very shy
Somewhat
shy
Moderate
Form E2 International Student Accommodation Application
Somewhat
Friendly
Very Friendly
and Outgoing
3
Has the student travelled to other countries before? If yes, where? _______________
_____________________________________________________________________
I hereby apply for Home Stay Accommodation for my child. I understand all Home Stay
Accommodation is assessed by the school for suitability and is monitored by
Coromandel Area School.





I have read understood and accept the policies, rules and procedures regarding
International Students at Coromandel Area School and agree to abide by them.
I agree that all disputes will be dealt with in accordance with New Zealand law.
I confirm all the information contained in this application is true and correct to the
best of my knowledge and belief.
I acknowledge that the provision of false information or the withholding of relevant
information may result in termination of enrolment.
I will inform the school if there are any changes to the details of this application.
Student’s signature: ________________________________
Parent’s Signature – if student is under 18 _____________________________
Parent’s Name: ______________________________________
Date:___________________
Form E2 International Student Accommodation Application
4