New Applications – SPCNM Enrolment

1Contact Details

2Education, Language and Nationality

3Disability, International Students

4Next of Kin

5Qualification & Course Enrolment

PERSONAL DETAILS

Title

What is your full legal name?*

As shown on your formal identification documents

Preferred First Name*

Previous Name/s known by:

Date of Birth (DD/MM/YYYY)*

Gender*

CONTACT DETAILS

Phone or Mobile Number*

Alternate Phone Number

Personal Email*

Street Address

Street Number*

Street*

Suburb/Town*

City/Region

Postcode*

Country*

Postal Address

PO Box

Street Number

Street

Suburb/Town

City/Region

Postcode

Country

EDUCATION & EMPLOYMENT

NSN (National Student Number) if known:

Are you still at school?*

Last School Attended (state Overseas if applicable)*

Last Year at Secondary School (YYYY - e.g. 2018)*

Highest Secondary Qualification*

First Year of Formal Education (YYYY - e.g. 2019)

What qualification were you awarded?

Are you eligible for Fees-free?*

What was your main activity prior to study?*

Language

What is your first language?*

Nationality

See further information in our Terms and Conditions Documentation section at the end of this form.

Citizenship (Country)*

Residential Status*

NZ or Australian Citizen (Not a Permanent Resident)

Permanent Resident (Excludes NZ & Australian Citizens)

Ethnicity*

Ethnicity 2

Ethnicity 3

Iwi Affliation

Iwi Affliation 2

Iwi Affliation 3

Disability

I understand that the completion of this question is not compulsory and that any information I supply is confidential.*

Yes

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

If yes, how would you describe your disability?

INTERNATIONAL STUDENTS ONLY

Passport Number

Passport Expiry Date (DD/MM/YYYY)

Passport Country

Visa Number

Visa Type

Visa Expiry Date (DD/MM/YYYY)

Nationality

Overseas Address

Street Number

Street Name

Suburb Town

City/Region

Postcode

Country

NEXT OF KIN

Relationship*

First Name*

Last Name*

Phone or Mobile Number*

Email*

PERSONAL DETAILS

CONTACT DETAILS

Street Address

Postal Address

EDUCATION & EMPLOYMENT

Language

Nationality

Disability

INTERNATIONAL STUDENTS ONLY

Overseas Address

NEXT OF KIN

QUALIFICATION ENROLMENT

NZ CERTIFICATE IN STUDY & CAREER PREPARATION

BACHELOR OF NATURAL MEDICINE COURSE ENROLMENT

PERSONAL INTEREST COURSE ENROLMENT

DECLARATION