2023 INZONE APPLICATION FORM

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

Student's home address *

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Permanent Resident *

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?

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? *

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?

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) *

Other Ethnicities - You may select more than one

What is the religion of your whānau?

Do you practice your religion?

B. RANGATAHI INTERESTS AND ACHIEVEMENTS

Please provide information about your tamariki's;

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)

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 *

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

+ Add another

B. PARTICULARS OF PARENTS/GUARDIANS WHO LIVE AT DIFFERENT ADDRESS TO RANGATAHI

Parent/Carer at different address

First name

Last name

Relationship with Student

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

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

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

Date of Birth

+ Add another

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 *

E. RESIDENCE OF THE PARENTS/GUARDIANS

What residence do you occupy? *

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

Please tell us how you heard about us *

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.

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

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