New Zealand College of Chinese Medicine

Please note that you can either enrol online or download and print the paper application form and mail it to us.

Download the Application Form

Application for Academic Place of Study

IMPORTANT INFORMATION - PLEASE READ

Please read this form carefully and make sure you understand all the information requirements before completing the form. The information required in this form is for statutory reporting purposes and to enable NZCCM to be compliant with its administrative obligations to NZQA and MOE. You will be required to sign a declaration of factuality and accuracy. You must ensure that you have all your questions regarding information contained in this form and required by it, answered to your satisfaction before providing any information. If there are any sections or questions you are not sure about please refer your questions to the Administration Support Staff.

THIS APPLICATION IS ONLY VALID WHEN THE APPLICATION FEE of NZ$200 IS PAID.

Application for Student Intake

Starting Semester

Select the Campus

Contact Details

First Names (required)

Middle Names

Family Name (required)

Preferred First Name

Gender

Preferred Title

Birthdate ( 'dd/mm/yy' )

Residential Street Address	Suburb	City	Country
Postal Address *	Postal Suburb *	Postal City *	Postal Country *

Contact Phone

Mobile Phone

Email (required)

* only required if the postal address is different from the residential address.

Safety Issues, Emergency Information And Instruction

IMPORTANT INFORMATION - PLEASE READ

In the event that you, for whatever reason, failed to attend a scheduled lecture and had not been able to notify NZCCM or were unable to make decisions or act in your own best interests NZCCM would be obliged to take appropriate emergency action as required and that a Nominee of your choice is notified pursuant to our pastoral care and protection obligations.

Nominee's First Names	Nominee's Family Name	Nominee's Relationship to You
Nominee's Street Address	Nominee's Suburb	Nominee's City
Postal Address (if different)	Postal Suburb (if different)	Postal City (if different)
Contact Phone	Mobile Phone	Email
Nominee's First Language	Does the Nominee speak English?

Please provide details of any medical condition, medication regime or disability you live with that might impact on your study or attendance or that might require specialised treatment and or rapid response from NZCCM as per your instruction, or external medical assistance.
If you have you have had any criminal convictions in the past five years please provide brief details.

Applicant's Student Status What is your residential status?
	New Zealand Permanent Resident or Australian
	MFAT Scholarships including Aotearoa and short-term training and post-graduate
	Full fee paying foreign student (excluding Foreign research-based post-graduate)
	Exchange scheme approved by Ministry of Education
	Foreign research-based post-graduate
	Military personnel, diplomatic staff or family, or persons associated with Operation Deep Freeze


What was the highest academic qualification you gained as at the time of enrolment?
	No formal secondary school qualification/ less than 12 credits at level 1
	School Certificate (one or more subjects) / 12 or more credits at level 1 or above / NCEA level 1
	Sixth Form Certificate (one or more subjects) / 12 or more credits at level 2 or above
	University Entrance / National Certificate Level 2
	Higher School Certificate / 12 -39 credits at level 3 or above
	Entrance Qualification from Bursary Exam / 40 or more credits at level 3 or above
	A or B Bursary / National Certificate Level 3
	University Scholarship
	Overseas qualification (includes International Baccalaureate)
	Other
	Not Known

What was the name of your last secondary school?	What was your last year at secondary school?
What was your first year at a tertiary education institute?	What programme of study are you enrolling in?

Activity Information What was your main activity as at October last year?
	Secondary School Student
	Non-employed or other Beneficiary (exclude retired)
	Wage or Salary Worker
	Self-employed
	University Student
	Polytechnic Student
	College of Education Student
	House-person or Retired
	Overseas (irrespective of occupation)
	Private Training Establishment Student
	Wananga Student
	Other

Referral Information How did you hear about NZCCM?
	Newspaper
	Telephone Directory
	Other Advertising
	Past or Current Student
	Qualified Practitioner
	Internet
	Recruitment Agent
	Other

Enrolment & Fee Information

Are you enrolling as an:
	International Student
	Domestic Student

How will you pay your tuition fees?
	Study Link Student Loans and Allowances
	Own funds
	Parents
	Other source of finance
	Grant or scholarship

Declaration Of Compliance I declare that I have:

	Read all the policies, terms and conditions that apply at New Zealand College of Chinese Medicine as they will apply to me and have had all my questions answered to my satisfaction and agree to abide by and be bound by the same. In particular I acknowledge that:
	Read and understand the fee payment policy and refund policies and I agree to be bound by them.
	I understand that from time-to-time NZCCM may alter or amend courses without notice or consultation with students.
	Under the terms of the New Zealand Privacy Act 1993, I consent to providing personal information to NZCCM and understand the information may be used for purposes related to my capacity as a student and reported to other Government and Non-Government agencies as required of the New Zealand College of Chinese Medicine.
	I understand that I have the right to see and correct, if necessary, the information which I have provided.
	I am aware that there may be video cameras operating in classrooms and that these may be viewed by authorised students, staff, parents and law enforcement agencies and I also approve the use of these videos for research, learning support and teacher development purposes.
	I declare that the information provided by me in this form is true and correct to the best of my knowledge and that supplying false, inaccurate or incomplete information about myself may lead to my immediate expulsion.
	I am aware that I must advise NZCCM of any changes in my circumstances and will notify the college of each and every occasion where I cannot attend a scheduled class prior to the start of that class.
	I understand the college reserves the right to cancel a course or qualification if there are insufficient enrollments.

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JACK