Domestic Application Form - School of Health

NZSE Domestic Application Form - School of Health

The purpose of this application form is to obtain from you the information we need to enrol you into NZSE College. We are required to collect information from you which is required by the Ministry of Education and other Government agencies for statistical and registration reasons. Please note: NZSE College is a state-funded tertiary provider. All sections of this form must be completed. Until this form is fully completed, and the necessary documentation provided we are not able to process your application. If you have any questions, please do not hesitate to ask. Please ensure you have the following documents ready to be uploaded if you wish to streamline the application process. Otherwise please contact us if you need any assistance at 0800 99 88 11.
Select your Programme / Course*

Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Select an available Intake*
Selected Programme (hidden)
Total
How would you like to attend your sessions?

Face to FaceOnlineBlended

Applicant Information

Please note: If applicant is under 18 years of age, the application must be signed by the parent/guardian and all correspondence regarding your application will be forwarded to your education agent and/or to your parent/guardian.
Are you over 18 years of age?*

YesNo
Basic Details

Please make sure keep a legal ID handy, and fill the form with your legal names, double check the date of birth and other relevant fields.
First Name(s):*
Middle Name(s):
Last Name:*
Preferred Name(s):
Your Date of Birth*

DayMonthYear
Date
Preferred Title*
Gender*

Contact Details

Please make sure you enter your legal name and date of birth which matches your ID.
Email*
example@example.com
Mobile Phone*

Pre-FixPhone Number
Secondary Phone

Pre-FixPhone Number
Address*
Mailing Address Line 1
Suburb*
City*
Postal/Zip Code*
Country*
Citizenship and Residency

To qualify as domestic student, you must be a New Zealand citizen (including students from the Cook Islands, Tokelau or Niue who have New Zealand citizenship) OR hold a resident visa, permanent resident of New Zealand OR a permanent resident of Australia residing in New Zealand.
Citizenship Status*
Citizenship*
Country of Birth*
Ethnicity*
Second Ethnicity
Third Ethnicity
If you identified as New Zealand Māori, with which Iwi do you identify?*

Emergency Contact Details (Next of kin)

A staff member may contact the nominated emergency contact, in relation to the applicant’s wellbeing and safety: (a) should there be an uninformed absence of over three days (b) a medical emergency, or (c) reasonable grounds for believing that the disclosure is necessary to prevent or lessen a serious threat to the student’s life or health.
First Name*
Last Name*
Relationship to applicant*
Emergency Contact Mobile Number*

Area CodePhone Number
Emergency Contact Email
example@example.com
Youth Provider Details (if applicable)

A staff member may contact the nominated contact, in relation to the applicant’s wellbeing and safety: (a) should there be an uninformed absence of over three days (b) a medical emergency, or (c) reasonable grounds for believing that the disclosure is necessary to prevent or lessen a serious threat to the student’s life or health.
First Name
Last Name
Organisation Name
Contact Mobile Number

Area CodePhone Number
Emergency Contact Email
example@example.com

Academic Background
Role prior to application (Previous year)*
Name of Last High School Attended*
Last Year of High School*
What is the highest level of achievement you hold from a high school*
Is this the first year you have enrolled in a tertiary provider since leaving school?*

YesNo
If you answered “No”, please enter the name of the organisation and Programme you studied at and the Year of your First Enrolment:
Name of the Organisation
Programme Name
Year of First Enrolment

Disabilities/Health

This information is confidential to NZSE College but it could be used by the Student Advisors to obtain further resources and support that will assist you in your studies.
Do you have a disability and/or medical condition (this could include both diagnosed and non-diagnosed health conditions? (NOTE: This information will remain confidential).*

YesNoPrefer not to say
If "Yes" is answered, please select all that apply regarding your disability/or medical condition (NOTE: This information will remain confidential):*
Do you have any medical condition (including allergies) that may require the school to provide assistance? (NOTE: This information will remain confidential).

YesNo
If "Yes", please outline your needs:
Are you taking any medication for your illness/disability? If so, please state:

File Upload

Please upload the correct files listed below (fields marked with an * are required). Please ensure files are named appropriately before uploading.
Upload Certified Copy of Citizenship/Residency Evidence Document:

A certified copy means a photocopy of your original document, signed as being a true and accurate copy by a Justice of the Peace, Solicitor, Minister of the Church, General Practitioner or School Principal. Otherwise, our NZSE College Recruitment Consultant will photocopy all originals and verify the copies.
Cancelof
ID Upload

if your photo is not verified by a Justice of Peace (JP), you will need to have this sighted and stamped by a JP and emailed to domestic.recruit@nzse.ac.nz OR taken into one of our campuses
Please tick which document(s) you will attach to your form (Please attach on the File Upload page):*

Birth CertificateNew Zealand PassportCertificate of Citizenship or Letter of ConfirmationOverseas Passport with ResidencyA Statement of Whakapapa including date of birth, countersigned by Kaumatua
Please upload your Birth Certificate:

Cancelof
Please upload your New Zealand Passport:

Cancelof
Please upload your Certificate of Citizenship or Letter of Confirmation:

Cancelof
Please upload your Overseas Passport with Residency:

Cancelof
Please upload your a Statement of Whakapapa including date of birth, countersigned by Kaumatua:

Cancelof
Academic Transcripts Upload:
Academic Transcripts:

Cancelof
Employment References Upload:
Employment/Job References:

Cancelof
Student ID Photo

Click the "take photo" button below to take a selfie of yourself, and we will use this as your school photo ID. Please make sure your facial features must be visible.
How would you like to pay?*

I pay now onlineI pay on siteI need assistance, please contact me

Terms and Conditions
Please review our Terms and Conditions to understand your rights regarding your personal information, and acknowledge it by ticking the box below.
I have read the Terms and Conditions?*

Yes
I declare that to the best of my knowledge, all the information supplied on, and with this application form is true and complete. I agree to abide by the conditions above, and I consent to the disclosure of personal information as described above. I give NZSE College consent to access prior learning records through my NSN number and literacy and numeracy results through TEC.*

I acceptI decline
Applicant Signature (if over 18 years old)*

Clear
Date

DayMonthYear
Date
Parent/Guardian Signature (If student is under 18 years old)

Clear
Parent/Guardian: Please attach a copy of Photo ID (e.g. Passport, Driver's License)

Cancelof
Should be Empty:

NZSE Domestic Application Form - School of Health

Applicant Information

Basic Details

Contact Details

Citizenship and Residency

Emergency Contact Details (Next of kin)

Youth Provider Details (if applicable)

Academic Background

Disabilities/Health

Declaration

Immunisation Declaration

Criminal Record Declaration

Image Disclaimer

Device Declaration

Authorisation to contact Employer

School of Health and Wellbeing Fitness Statement, Health and Safety Declaration

File Upload

ID Upload

Academic Transcripts Upload:

Employment References Upload:

Student ID Photo

Terms and Conditions