ENROLMENT APPLICATION FORM

28a Linwood Avenue, Mt Albert, Auckland 1025, New Zealand. Postal Address: PO Box 2995, Auckland 1140, New Zealand.
Telephone: (64-9) 815 1717 Email: [email protected] Internet: www.ais.ac.nz
Welcome to Auckland Institute of Studies. Please read the instructions
below carefully before you complete this form.
We need the following information to offer you a place at Auckland Institute of Studies (AIS). We also need to collect information for the Ministry
of Education and other government agencies for statistical and registration reasons. The form also sets out the legal conditions of your enrolment
with AIS.
You (the applicant/prospective student) must:
• COMPLETE Sections A-K printing answers clearly, or ticking the box that applies in pen; and
• SIGNING the form and attaching any additional required documentation.
A QUALIFICATION
1 Name of the qualification/s in which you wish to enrol:
Start date Duration
a) Specialisation
Start date Duration
b) Specialisation
Start date Duration
c) Specialisation
2 Have you studied at AIS before? No Yes What was your AIS Student ID number?
B PERSONAL DETAILS
1 Family or Surname 2 Given Name(s)

3 Date of birth (DD/MM/YYYY) 4 Gender Male Female Another Gender

5 Title Ms Miss Mrs Mr Other(specify) 6 Mailing address for documents/communications (if different from
home address)
7 Home Address

Country Country
Phone Mobile
Email

8 If you know your NSN (National Student Number), please write it here:

9 Disability Status
Do you have an allergy, physical disability, mental health condition, long term medical condition or other impairment that we should be aware
of to facilitate your studies at AIS? The information you supply is confidential. Yes No
If Yes, please describe your disability, condition or other impairment:

10 Learning Support Needs

Is there support that would help you while learning at AIS? Your response allows us to let you know what assistance is available.
No - I do not need support at this time Yes - please select the support you may need:

Mobility support around campus Support with reading, writing and communicating in class Sign Language interpreter
Access to assistive technology Accessible format resources Other learning or disability support ....................................

C EMERGENCY CONTACT DETAILS

Please provide the details of your parent(s) / relative / next of kin whom we can contact in case of an emergency. If you are an international
student, this must be a person whom we can contact in your home country.

1 Name of Parent / Relative / Next of Kin 2 Relationship to applicant

3 Home address

4 Phone Mobile 5 Email

D CITIZENSHIP / RESIDENCY
Please supply evidence of residence or citizenship
1 What is your country of citizenship? 2 Passport Number (if not a NZ citizen):

3 If not a NZ citizen, do you have Permanent

Certified copy of my Resident Visa attached.
Yes No Yes No
Residency in New Zealand?

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:: E ETHNICITY
1 What ethnic group(s) do you belong to?

2 If you identified yourself as New Zealand Māori, what is the name of your iwi? You may enter more than one iwi.

F ACADEMIC INFORMATION
1 If English is your second language, how long have you studied English? years
In which countries?

Where did you study English? Secondary School Private Language School University/Institute/College
Name and result of examinations or qualifications in English, if any (IELTS, TOEFL, etc.):

What is your English language level? Beginner Elementary Intermediate Advanced

2 What was the name of the last secondary / high school you attended? Country:

How many years did you attend secondary / high school? years What year was your last year at secondary school?
Name your highest secondary / high school qualification:

3 Have you ever previously enrolled in a Tertiary Education (after secondary / high school) Institution? Yes No
Name of University / Institute / College: Country:

What year was your first year in tertiary education? How many years did you attend tertiary education? years
Name the highest qualification(s) gained:

4 Prior Activity. What was your main activity or occupation if you were in New Zealand at 1 October last year?
Secondary school student University student Overseas (irrespective of occupation)
Non-employed or beneficiary (excluding retired) Polytechnic student Private Training Establishment student
Wage or salary worker House-person or retired Wānanga student
Self-employed
5 Cross-Credits. Do you wish to apply for cross-credits? (N/A for Graduate Diplomas) Yes No
If YES, please complete a Cross-Credit Application Form on arrival at AIS, and include official course descriptions for each course for which
credit is claimed. Cross-credit application fees apply ($50.00 per course for studies in New Zealand, $275.00 per course for studies completed
overseas). There is no charge for courses included in approved articulation agreements with other providers, or for advanced standing credit
for New Zealand qualifications or unit standards achieved.
G SERVICES
1 Accommodation. Do you wish to apply for accommodation (AIS dormitory or homestay)? Yes No
If YES, you must submit your Accommodation Application Form at least two weeks before your arrival date (AIS dormitory) or four
weeks before arrival (homestay).
2 Medical Insurance
Do you wish AIS to purchase your travel and medical insurance on your behalf? Yes No
If YES, please select your insurance provider below and complete the relevant insurance application form
(download at www.ais.ac.nz/insurance). Southern Cross Travel Insurance Uni-Care Student and Visitor Travel Insurance
If NO, please provide a copy of your Medical Insurance. Attached: Yes No
Note: Travel/Medical Insurance is compulsory for international students – see www.ais.ac.nz/insurance for a list of alternative approved providers.
3 Airport Transfer/Pick up. Do you want an AIS representative to meet you at Auckland Airport when you arrive? (Fees apply)
No Yes If YES, you must notify AIS two weeks before your arrival date.
4 Marketing. How did you hear about AIS?
Friend / Family Agent Internet Search (please specify)………………....……….…...........……….….....................

Education Fair/Expo Other Advertisement (Where was the advertisement?)………………....……….…....................

5 Declaration of Agent. Are you using the services of an Agent for your enrolment application? Yes No
If YES, the business name of your Agent is:
H DOCUMENTATION
You must provide CERTIFIED COPIES of the following: Attached (please tick)
• Birth Certificate or Passport
• Academic Certificates and Transcripts
• Evidence of a legal change of name if the name on your application form is different
to your relevant evidence, e.g. marriage certificate, deed poll declaration
A CERTIFIED COPY means a photocopy of your original document signed as being a true and accurate copy by a Justice of the Peace
(JP), Solicitor, Notary Public, or Approved Representative of AIS.
I PAYMENT DETAILS
Please send fees as follows, citing your Student ID as reference:
a) By NZ Dollars Telegraphic Transfer (T/T):
Account Name: Jolly Duncan & Wells Trustees Ltd AIS Student Trust
Bank Name: ASB Bank Limited
Bank Address: 12 Jellicoe Street, Auckland CBD, Auckland 1010, New Zealand
Account No: 12-3237-0004134-01
International Swift Code: ASBBNZ2A
b) By online banking to “Jolly Duncan & Wells Trustees Ltd, AIS Student Trust”at the Account Number above.
c) By Online EFTPOS or selected credit cards (VISA, Mastercard) via the AIS website (https://www.ais.ac.nz/payment-form).
Note: All bank charges must be paid by the applicant.
October 2024 Page 2 of 4
 J STUDENT DISCLOSURE INFORMATION
Enrolment, Payment, Withdrawal and Refund Policy, and Complaints Procedures
a) Application Procedure
(i) You must complete all sections of the AIS Enrolment Application Form, attach all relevant certified information, and when completed forward to Sales
and Marketing at AIS. Applications are assessed and upon acceptance a Quotation and Offer of Place will be provided.
(ii) International Students Only. Please see the Immigration New Zealand website for information on applying for a visa to study in New Zealand.
Upon receipt of our Offer of Place, you may undergo “Pre-Visa Assessment” by applying for a visa, and you should receive Approval In Principle prior
to paying tuition fees. Alternatively, transfer full payment to the AIS Student Trust account. All fees are converted to New Zealand Dollars at the
time of receipt. After your payment is processed, you will be sent a Receipt for fees paid and a Confirmation of Enrolment document including an
accommodation guarantee if required. You must send the Receipt and Confirmation of Enrolment document when applying for the Student Visa to be
issued. If you require Airport Pick-up and/or accommodation, you must inform AIS at least two weeks before your arrival in New Zealand.
(iii) Domestic Students Only. Transfer payment of fees to the AIS Student Trust account prior to the commencement of your programme. If you are
funding your course through a Student Loan, you should finalise your Student Loan application with StudyLink and arrange for any balance of fees to
be paid to AIS prior to commencement of studies. Successful applicants will be sent an Invoice. A Receipt will be issued when payment is made.
(iv) Bring Your Own Device (BYOD). AIS uses e-books and other electronic methods to deliver quality education in a BYOD environment. Your own device
should meet the following minimum standards: an iOS 13, Android 12 or MS Windows 11 operating system in English and compatible with Office 365,
at least a 10-inch screen or larger, memory 8GB (or preferably 16GB), Wi-Fi capability, and with mouse, keyboard/touchscreen, webcam, microphone
and speakers (Chromebooks are not supported).
b) Fees Protection
(i) Trust Account. All student fees are deposited directly into an independent Chartered Accountant’s Trust Account and are released to AIS in the
following manner:
• Tuition fees - the lesser of 20% or $3,000 is released to AIS after the statutory withdrawal period after commencement of the programme, and the
remaining amount periodically in arrears on a pro rata basis in relation to the tuition delivered.
• Accommodation or living costs - periodically in arrears on a pro rata basis.
(ii) If necessary, the Trustee can be contacted at: Jolly Duncan & Wells Ltd, 127 Main Highway, Ellerslie, Auckland (PO Box 11053, Ellerslie, Auckland 1542),
Tel: (64-9) 579 7096, Attention: Serena Irving, Email: [email protected].
c) Arrival at AIS. On arrival at AIS, please bring evidence of your identity, citizenship or visa status. For international students, a copy of your Medical
Insurance Certificate must also be supplied to AIS.
d) Payment
(i) Students who are not up to date with payments of fees will not be entitled to continue the qualification or to graduate from it.
(ii) If payment is overdue, AIS will charge penalty interest on any overdue amount at the rate of 2.5% per month from the overdue date until payment in
full is received by AIS.
(iii) The student will upon demand pay all AIS expenses and legal costs (on a solicitor/agent/representative/client basis) in the collection of all overdue fees,
plus debt collection agency costs.
e) Withdrawal and Refund Procedures
(i) (a) International students: For programmes over three months, all payments exceeding up to 25% of the fees paid will be refunded if the student
withdraws within the first ten working days after the first day the student is required to be at AIS to commence the programme of studies enrolled
in. After this, fees paid are non-refundable. Students withdrawing within one month prior to the start of the programme will be entitled to a refund
less a deduction of 17.5%. International students withdrawing earlier than one month prior to the start of the programme will be entitled to a
refund less a deduction of NZ$500 or 10% of the fees paid, whichever is the lesser.
(b) Domestic students: For programmes over three months, all payments exceeding NZ$500 or 10% of the fees paid, whichever is the lesser, will be
refunded if the student withdraws prior to or within the first seven days after the first day the student is required to be at AIS to commence the
programme of studies enrolled in. After this, fees paid are non-refundable.
(ii) For programmes of five weeks or more but less than three months, 75% of the fees paid will be refunded if the student withdraws prior to or within
the first five days of the programme commencement. After this, fees paid are non-refundable.
(iii) For programmes under five weeks, 50% of the fees paid will be refunded if the student withdraws prior to or within the first two days of the
programme commencement. After this, fees paid are non-refundable.
(iv) Any applications for withdrawal must be made on a Programme Withdrawal Form, along with a Tuition Fees Refund Request form, and must state
reasons in full. Written confirmation from the student’s parents, legal guardian or agent is required if the enrolment was made through them, as well
as an interview with a Student Services staff member, and refunds will be transferred to the original source. If the student is transferring to another
institution, a copy of the new offer and quotation must be provided for the direct transfer of fees.
(v) If a student fails to attend or participate in the programme, or stops attending or participating in the programme before the end of the refund period,
the student will be treated as having withdrawn within the refund period.
(vi) Interim visas. Normal withdrawal fees will apply if a student starts on an interim visa and withdraws before the result of the student visa application is
known. Where the student visa application is declined while studying on an interim visa, fees will be charged on a pro rata basis based on the number of
weeks attended and the balance of fees will be refunded.
(vii) A minimum of two weeks’ written notice must be given for cancellation of dormitory or homestay accommodation arrangements, except where less
than four weeks’ homestay accommodation is booked, a minimum of one week’s written notice must be given.
(viii) Full refunds will be given in the case of cancellation by AIS of a course/qualification before or during the course/qualification, or if the student visa is
declined by Immigration New Zealand.
(ix) Withdrawals from courses received after 14 calendar days and before the end of the fifth week of the programme will incur a grade of ‘WD’
(Withdrawn). Withdrawals from courses within the programme received after the fifth week of the trimester will incur a grade of ‘E’ (Failure to
complete). In the case of unsatisfactory performance where withdrawal is initiated by the institute, a grade of WD will be incurred.
(x) In the case of a course closure event, the institute will ensure that students enrolled at the time are able to complete their programmes through a
teach-out process, or that appropriate alternative provision of education is available. In the case of voluntary closure by the provider, refunds will be
given in accordance with the Student Fee Protection Rules 2022.
(xi) Applications to change education provider require approval from Immigration New Zealand, and students must study in accordance with their Student
Visa while awaiting a decision from Immigration New Zealand.
(xii) Refund requests outside the above criteria should be submitted in writing to the Academic Registrar for special consideration.
(xiii) Fees are not adjusted if an international student’s immigration status changes to Permanent Resident during the enrolment period paid for.
(xiv)Fees are non-refundable if a student is expelled or suspended by AIS, or if enrolment is terminated due to unsatisfactory progress.
f) Student Grievances. In the first instance, issues should be discussed with a student support staff member, a teacher, another staff member, or a student
representative. Failing satisfactory resolution, students may make an appointment with, or write to, the head of programme, Head of Marketing or the
President. If necessary, complaints may be submitted in writing to the following external authorities: New Zealand Qualifications Authority, English New
Zealand, or Study Complaints - Ngā Amuamu Tauira. Full contact details are contained in the AIS Student Handbook.
g) Disciplinary Measures. Students who violate the Student Code of Conduct, rules and regulations of AIS will be subject to a range of disciplinary actions
and penalties, in accordance with Policies and Procedures in Section 3.1 Registry, sub-item Student Conduct and Discipline. Penalties range from a verbal
or written warning for minor misdemeanours, to referral to the Student Disciplinary Committee (SDC) for major violations, or to public law enforcement
agencies if required. Disciplinary measures available to the SDC include minor and major demerit points, removal of marks and direction to repeat courses
for plagiarism or cheating in assessments, escalating to suspension or expulsion for the most serious matters. In accordance with the principles of natural
justice, students have the right to appeal to the Review and Appeals Committee.
h) Termination. The SDC has the right to suspend or expel a student for an accumulation of three major demerit points, or for serious offences such as
assault, theft, possession of drugs, illegal access to computer systems, or other actions that lead to police intervention. In addition, the Academic Board
has the authority to terminate enrolment based on unsatisfactory academic progress.
i) AIS reserves the right to decline an application from any applicant without explanation.
Note:
(a) Withdrawal and refund procedures are in accordance with the Education and Training Act 2020 and its subsequent amendments.
(b) Your name, date of birth and residency as entered on this form will be included in the National Student Index, and will be used in authorised information
matching programmes with official government information such as the New Zealand Birth Register, to verify the information provided.
(c) Offering of programmes and courses is subject to minimum enrolment numbers. AIS reserves the right to cancel or postpone a programme or course if
required.
October 2024 Page 3 of 4
 K DECLARATION BY APPLICANT (PROSPECTIVE STUDENT)
a) I declare that the information supplied on and with this enrolment form is true and complete. I also understand that AIS may suspend or terminate
my enrolment if any falsified documents are discovered during the application or enrolment process or during my study.
b) I have read and accept the Enrolment, Payment, Withdrawal and Refund Policy, and Complaints Procedures above.
c) In signing this enrolment form, I undertake to pay all fees as they become due, including any late fees and debt collection charges.
d) In signing this enrolment form, I undertake to comply with the published rules and policies of AIS, including attendance, academic integrity and
progress, conduct, and use of information technology resources.
e) I undertake to provide up-to-date address and contact details at all times, and up-to-date copies of my visa and Medical Insurance Certificate and
any renewal.
f) Privacy Act 2020. I authorise any person or company to provide to AIS such information as required in response to credit and enrolment enquiries.
I further authorise AIS to furnish to any governmental organisation or agency and to any other third party, including my parents/legal guardian if I
am under 18, details of my enrolment application and subsequent dealings. Such information includes attendance and academic records that I may
have as a result of my application being actioned and accepted by AIS. (Data storage - data collected from tertiary education organisations is now
stored in the Cloud. Student enrolment and course and qualification completion data is stored in a Microsoft datastore based in Sydney, Australia.)
I give this authorisation on the understanding that the institute will observe the general conditions governing the release of information, as set out
in the Privacy Act 2020, and that I may see any information held about me and amend any errors in that information by contacting the Academic
Registrar.
g) I authorise AIS to discuss my student visa application for AIS with Immigration New Zealand, including via industry associations such as English New
Zealand and ITENZ, to obtain information regarding the processing of the visa application and the decision on the application.
h) I acknowledge that if I am an international student, I must have approved travel and medical insurance cover while I am studying in New Zealand
and until the student visa expiry date.
i) Statutory Information Statement for Students Required under Section 354(b) of the Education and Training Act 2020. Auckland Institute of
Studies Ltd (trading as AIS ) is required to provide prospective students with a written statement covering the information listed below before
accepting their enrolment.
(i) The total costs and other financial commitments associated with the programme or training scheme for which the student seeks enrolment: Refer to
the current Fees Schedule which can be downloaded at www.ais.ac.nz/student-fees. For fees for additional services, refer to the Supplementary Fees
List which can be downloaded at www.ais.ac.nz/student-fees.
(ii) The cost of fees charged for student services provided by the establishment: Refer to the information on the Student Services Fee at www.ais.ac.nz/
student-fees.
(iii) Any material conflicts of interest of any of the governing members of the establishment: There are no governing members of AIS that have material
conflicts of interest.
(iv) Any interests that any governing member of the establishment has in organisations in the education or immigration sector that provide goods or
services to tertiary students: The Directors of AIS (Allen Hsieh, John Wood, Richard Smith, Peter Ou, Kevin Chen and Wendy Ku) are Directors of AIS
Properties Ltd which owns the campus properties from which the institute operates.
(v) For programmes extending across more than one year, the institute reserves the right to review its fees annually and students are advised to make
allowance for modest annual increases (in line with general cost increases). AIS also reserves the right to adjust fees as required in response to changes
by external suppliers. Students are liable for any exchange rate differential between the time of payment and receipt if payment is not made in NZD.
As a prospective student of AIS, I confirm that I have received a copy of this Statutory Information Statement and that I have received the information
referred to in i) (i) and (ii) above.

PLEASE SIGN AND DATE BELOW

Signature and name of applicant (prospective student):

Print name Signature Date

If not signed by the applicant, please sign and give name and relationship to applicant, and provide a written statement from the
applicant of your authorisation to sign on the applicant’s behalf:

Print name Signature Relationship Date

Signature of parent or legal guardian of applicant if applicant is under 18 years old:

Please fill out and attach a Student Under 18 Consent/Indemnity Form (available at www.ais.ac.nz/apply-now).

Print name Signature Date

For Office Use Only

Application Approval: Programme(s) ...................................................................................................................................................................................................

Approved Declined ........................................................................................ Date

Academic Registrar

Comments / Conditions

October 2024 Page 4 of 4