紐西蘭留遊學諮詢表 Consultation Form

學生基本資料 Basic Information

學生護照英文名 English Name (as shown on Passport)：

請與護照上的英文拼音相同，格式請照範例: Tsu Ting, Chen

Please match your passport spelling and use the format shown in the example.

學生出生年月日 Date of Birth：

性別 Gender

男 Male

女 Female

家長的英文名字 Parent/Guardian's English Given Name：

需與護照拼音相同

Must match the spelling on your passport.

家長英文姓氏 Parent/Guardian's Surname

需與護照拼音相同

Must match the spelling on your passport.

家長的Email信箱 Parent/Guardian's Email Address：

預計參加時間與週數 Intended Start Date and Duration (Weeks)

預計參加時間 Intended Start Date

2027年Term1: 1/28～2/3(開學期間)-4/9 2027 Term 1: 28 Jan/03 Feb (Start Date Range) – 9 Apr

2027年Term2: 4/27-6/2 2027 Term 2: 27 Apr – 2 Jul

2027年Term3: 7/19-9/24 2027 Term 3: 19 Jul – 24 Sep

2027年Term4 10/11-12/17 2027 Term 4: 11 Oct – 17 Dec

預計抵達日期 Estimated Date of Arrival (EDA)

請填寫預計何時抵達以便安排後續事宜，若之後日期更動可再告知我們。

Please provide your estimated arrival date so we can coordinate your arrangements. Don’t worry if your plans change—just let us know, and we will update your schedule accordingly.

預計就讀週數（限3週以上）Estimated Duration of Study (Minimum 3 weeks)

學校選擇偏好 School Preferences

傾向選擇的學校類型 Preferred School Type

私立學校 Private School

公立學校 State School

公私立混合 State-Integrated School

學校性別組成偏好 School Gender Composition Preference

男女合校 Co-educational

單一性別學校（男校／女校）Single-sex School

住宿安排與生活需求 Accommodation and Living Requirements

是否需要安排寄宿家庭？ Do you require Homestay arrangement?

是 Yes

否 No

若第5題回答「是」，請填寫以下問題

If you answered "Yes" to Question 5, please complete the following sections.

是否有食物過敏？若有，請詳述 Do you have any food allergies? If yes, please specify.：

是否有特殊飲食需求（如素食、宗教飲食等）？請詳述 Do you have any special dietary requirements (e.g., Vegetarian, Religious diet, etc.)? If yes, please specify.：

有特別不吃的食物嗎？Are there any foods you particularly dislike or prefer not to eat?

是否願意遵守寄宿家庭規則（如作息、共享空間、協助簡單家事等）？ Are you willing to follow Homestay rules (e.g., house schedule, shared space etiquette, and assisting with light household chores)?

是 Yes

否 No

課後是否需要安排延後接送？（部分家庭因上班無法三點接送）Do you require after-school supervision or late pickup? (Some host parents may be at work and unable to pick up at 3:00 PM.)

需要 Yes / Required

不需要 No / Not required

視狀況而定 Depending on the situation / It depends

其他補充 Additional Information

其他特別需求或希望我們了解的事項 Is there anything else you would like us to know, or any special requests?：