Step 1 of 5 - Personal Details 20% Personal DetailsFull Legal Name (As on your formal ID - please include all middle names)* Preferred First Name* Previous Name/s known by: Date of Birth* Gender*FemaleMaleDiverseContact Details (if changed)Phone Number Mobile Personal Email Street Address (if changed)Street Number Street Suburb/Town City/Region Postcode Country Postal Address (if changed)PO Box Street Number Street Suburb/Town City/Region Postcode Country NationalitySee further information in our terms and conditions Documentation section at the end of this formCitizenship (if changed) NZ or Australian Citizen Permanent Resident (Excludes NZ or Australian Citizens) Not a Permanent Resident or a NZ or Australian Citizen) Fees Assistance Status* Domestic Student International Student Will you be studying in NZ or Overseas?* New Zealand Overseas What will your mode of study be?* On-campus Online Disability (If your situation has changed)Do you live with the effects of significant injury, long term illness, or disability?SelectYesNoIf yes, how would you describe your injury, illness or disability? International Students Only (If your details have changed)Passport Number Passport Expiry Date Passport Country Visa Number Visa Type Visa Expiry Date MM slash DD slash YYYY Nationality Next of Kin (if changed)Relationship First Name Last Name Phone Number Mobile Number Email COURSE ENROLMENT 2023Certificate of Personal Interest - Course ApplicationLimited places available. If applying to enrol in more than one course, please list your courses in order of preference in the 'Additional Comments' field at the end of this form.Semester Two Courses CPI04 Foundations of Research CPI05 Anatomy & Physiology 2 CPI06 Herbal Medicine 2 CPI07 Biochemistry of Foods CPI08 Rongoā Māori Healing Concepts I would like to study the course/s* With assessments Without assessments Additional Comments?DeclarationI have read the Terms and Conditions* I declare that, to the best of my knowledge, all the information supplied in and with, this enrolment form is true and complete. * I agree to abide by the conditions described in the Terms & Conditions provided. * I consent to the disclosure of personal information described in the Terms & Conditions provided. Signature* Type your name hereDate of Declaration* Please enter today's datePLEASE REMEMBER TO SUBMIT ANY ADDITIONAL DOCUMENTATION BY EMAILING firstname.lastname@example.org.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.