Please complete the application form below:


Full Name:

Full name as you would like it to appear on your certificates

Known As:

If different from above

Address:

Town or City:

Postal Code:

Date of Birth:

Email Address:

Contact Numbers:

Occupation:

Qualifications & Previous Training:

What are your personal motivations and goals for this training?

Best times/days for an interview? (if required)

Where specifically did you hear about NZSPH?

Any history of psychiatric illness? YesNo

If Yes, please provide full details here:

Any history of criminal convictions? YesNo

If Yes, please provide full details here:

Which training centre are you applying for:
AucklandWellingtonChristchurch

Which course are you applying for:

Select payment method:
Plan 1Plan 2Plan 3

Any additional information, comments or notes you wish to provide? YesNo

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