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- Application Form
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The GAP NZ Application Form

Provide a few details to bring your New Zealand travel closer

The Program

Program You Are Applying For *

Who is completing the application? *

Parent Student

Personal Details

Please make sure details are as they appear on your passport.

First Name *

Middle Name *

Surname *

Preferred name *

Sex *

Male Female Other

Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Home Phone Number *

Student's Cellphone Number *

Student's Email Address *

Do you hold a current passport? *

Yes No

What country is your passport from? *

Health Information

We have a no smoking policy, are you a smoker? *

Yes No

Do you get migraines or headaches? *

Yes No

Are you allergic to any medication? *

Yes No

Do you have musculoskeletal problems? *

Yes No

Do you have any recent history of mental health or psychological challenges? *

Yes No

Do you have any other physical problems that might affect your participation? *

Yes No

Do you have asthma or any respiratory problems? *

Yes No

Do you have any other health problems that may affect your participation? *

Yes No

Any other health problems that may affect your participation *

If you have answered yes to any of the above, please provide more information *

Please outline any medication you will need to take during the program *

Primary parent or gaurdian information

First Name *

Email *

Surname *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship to student *

Secondary parent or guardian information

First Name *

Surname *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Relationship to student *

How did you find out about The GAP NZ? *

Submit

CONTACT US

PHONE:
EMAIL: [email protected]

American Gap Association Member - In Process

The Gap NZ

Providing a gap year New Zealand vacation experience before you head to University or College spring admission.

New Zealand

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About Us
The Program
Program Dates
Apply
- Application Form
Contact Us
FAQ's
- Research
Blog