Step 1 of 5 - Personal Details 20% Personal DetailsFull Legal Name* 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 Permanent Resident (excludes NZ & Australian Citizens) Not a Permanent Resident (includes all NZ & Australian Citizens) Fees Assistance Status* Domestic Student International Student Will you be studying in NZ or Overseas? New Zealand Overseas DisabilityDisability* I understand that the completion of these questions is not compulsory. Any information you supply is confidential. Do you live with the effects of significant injury, long term illness, or disability?SelectYesNoIf yes, how would you describe your disability? I choose not to answer these questionsSelectYesNoInternational Students OnlyPassport 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 QUALIFICATION ENROLMENTSelect one of the following: Bachelor of Natural Medicine Personal Interest - Self-funded Certificate in Personal Interest courses Office use only: Current student qualification code Where will you study?In NZOverseasCOURSE ENROLMENT (Bachelor of Natural Medicine/Personal Interest)IMPORTANT NOTE: Please enter all of the courses that you will be studying in 2022 (based on your study pathway for Bachelor of Natural Medicine students). Please select On-line for all courses that you plan to take as a Blended learner (studying on-line but attending on-campus as often as you choose to):Year OneSemester One Courses On-Campus BNM542 Foundations of Research On-Campus BNM531 Herbal Medicine 1 On-Campus BNM541 Principles & Philosophy of Natural Medicine On-Campus BNM511 Anatomy & Physiology 1 On-Campus Semester One Courses On-line BNM542 Foundations of Research On-line BNM531 Herbal Medicine 1 On-line BNM541 Principles & Philosophy of Natural Medicine On-line BNM511 Anatomy & Physiology 1 On-line Semester Two Courses On-Campus BNM521 Biochemistry of Foods On-campus BNM532 Herbal Medicine 2 On-campus BNM643 Rongoā Māori Healing Concepts On-campus BNM512 Anatomy & Physiology 2 On-campus Semester Two Courses On-Line BNM521 Biochemistry of Foods On-line BNM532 Herbal Medicine 2 On-line BNM643 Rongoā Māori Healing Concepts On-line BNM512 Anatomy & Physiology 2 On-line Year TwoSemester One Courses On-Campus BNM633 Pharmacology & Pharmacognosy On-campus BNM622 Nutrition 1 On-campus BNM613 Pathophysiology 1 On-campus BNM652 Therapeutics 1 On-campus Semester One Courses On-line BNM633 Pharmacology & Pharmacognosy On-line BNM622 Nutrition 1 On-line BNM613 Pathophysiology 1 On-line BNM652 Therapeutics 1 On-line Semester Two Courses On-Campus BNM661 Managing a Professional Practice On-campus BNM723 Nutrition 2 On-campus BNM614 Pathophysiology 2 On-campus BNM753 Therapeutics 2 On-campus Semester Two Courses On-line BNM661 Managing a Professional Practice On-line BNM723 Nutrition 2 On-line BNM614 Pathophysiology 2 On-line BNM753 Therapeutics 2 On-line Year ThreeSemester One Courses On-Campus BNM551 Massage On-campus BNM715 Differential Diagnosis & Physical On-campus BNM762 Pre Clinic On-campus BNM763 Clinical Practice 1 On-campus Semester Two Courses On-campus BNM644 Mind & Body On-campus BM764 Clinical Practice 2 On-campus BNM765 Clinical Practice 3 On-campus BNM766 Clinical Practice 4 On-campus DeclarationI have read the Terms and Conditions Copy 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 above. I consent to the disclosure of personal information as described above. Signature* Type your name hereDate of Declaration* Make sure you enter today's datePlease remember to submit your documentation and complete all additional application requirements on Moodle.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.