Enrol in a course - College of Natural Health & Homeopathy

Which qualification do you wish to enrol in?*

Name*

First Last

Date of Birth*

Permanent Address*

Street Address City Country

Primary Phone Number*

Email Address*

Do you live with the effects of significant injury, long term illness, or disability? (The information you supply is confidential)*

If “Yes”, how would you describe your impairment, disability, or long term medical condition?*

Citizenship and Residency

Are you a domestic or international student?*

During your enrolment in this qualification will you be residing in New Zealand or overseas?*

What was your MAIN activity or occupation during the last year? You may tick only one box.*

What is the highest level of achievement you hold from a secondary school?*

Please specify*

Will this be the first year you have ever enrolled in Tertiary Study either in New Zealand or overseas since leaving high school?*

Please enter the name of the institution you studied at most recently*

If you have completed one or more tertiary qualifications enter the name of the highest level qualification.*

Name	Level (if known)

Signature*

Please enter your FULL NAME as your signature

Signature Date*

How did you hear about us?