Application Form – SPCNM Enrolment

The information collected from this form is for the sole purpose of applying to study at SPCNM.

Make sure that you check all questions are answered correctly without spelling or typo errors as this can delay the process of your application. Please note that the form has required information (marked with an *) that needs to be completed before it can be submitted. We may require you to complete another application if we are not satisfied with the information you have provided. Once you have completed the form and submitted the form, please submit your supporting documents and pay your application fee.

New application or course enrolment?*

Personal Details

Title*

Full Legal Name (As shown on your formal identification)*

Preferred First Name*

Previous Name/s known by

Date of Birth*

Gender*

National Student Number (NSN)

Are you eligible for Fees-free study?*

Contact Details

Home Phone

Mobile*

Personal Email*

Home Address

Street No*

Street*

Suburb/Town*

City/Region*

Postcode*

Country*

Postal Address

PO Box

Street No

Street

Suburb/Town

City/Region

Postcode

Country

Education

Are you still at school?*

Last school attended? (State Overseas if applicable)*

Last year at Secondary School? (e.g. 2015)*

Highest Secondary Qualification*

Will this be your first Year of Tertiary education?*

What year was your first enrolment?

What qualification were you awarded?*

What is your main occupation currently?*

Language

What is your first language?*

Nationality

Citizenship*

Residential Status*

Fees Assistance Status*

Ethnicity*

Ethnicity

Enter Your Ethnicity Here.

Please type your ethnicity if it has not been stated in the drop down list above.

Ethnicity 2

Ethnicity 3

Iwi Affiliation

Iwi Affliation 2

Iwi Affliation 3

Injury, Illness or Disability

I understand that my response will be visible to my lecturers and limited administration staff, and that the completion of this question is not compulsory.*

(NB: The College will need to be informed in order to provide assistance where required.)

Agree

Do you live with the effects of significant injury, long term illness, or disability?

If Yes, how would you describe your disability*

Identified Barriers to Learning*

To help us prepare and provide sufficient support please enter up to three barriers that you believe may have an impact on your studying at SPCNM.

International Student Details

Passport Number*

Passport Expiry Date*

Passport Country*

Visa Type*

Visa Number*

Visa Expiry Date*

DD

MM

YYYY

Nationality*

Overseas Address

Please Complete this section if you are located overseas

Street No

Street

Suburb/Town

City/Region

Postcode

Country

Next of Kin

Relationship*

First Name*

Middle Name

Last Name*

Home Phone

Mobile*

Email*

Qualification

I am applying to enrol in the following qualification*

Select one of the following modes of study*

I am enrolled in the following qualification*

Will you be studying in NZ or overseas?*

Personal Interest Course Enrolment

Please check the SPCNM website for our guidelines before you select your Personal Interest course and enter the courses that you will be studying in 2021 only.

YEAR ONE

Semester Two 2021 Courses On-campus

CPI521 Biochemistry of Foods On-campus
CPI512 Anatomy and Anatomy 2

* For this semester you may only choose from CP1521 Biochemistry of Foods or CPI512 Anatomy and Physiology 2

Semester Two 2021 Courses On-line

CPI521 Biochemistry of Foods On-line
CPI512 Anatomy and Physiology 2

* For this semester you may only choose from CP1521 Biochemistry of Foods or CPI512 Anatomy and Physiology 2

Intention to progress to the Bachelor of Natural Medicine degree programme.

I intend to to apply to enrol into the Bachelor of Natural Medicine degree programme once I successfully complete this programme.

Additional Comments

Section Break

This section is only for Bachelor of Natural Medicine degree programme applicants.

YEAR ONE

YEAR TWO

YEAR THREE (available On-campus only)

This section may only be completed by Bachelor of Natural Medicine students or applicants. Please indicate the courses for which you may request RPL or CRT.
Full instructions will be provided later in the enrolment process. NB: For any courses that you may apply for RPL or CRT, please also select them in the course enrolment section (above).

Comments

Declaration

I 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.*

Yes

I agree to abide by the conditions described above.*

Yes

I consent to the disclosure of personal information as described above.*

Yes

Signature*

Type your name

Date*