New Zealand College of Chinese

Medicine
International Enrolment Form 2024

P O Box 17467, Greenlane Phone: 09 580 2376 or 0800888518

Auckland 1546

Email: enrolment@chinesemedicine.ac.nz

Welcome to the New Zealand College of Chinese Medicine. Please read the instructions below carefully before you
complete this enrolment form.
INSTRUCTIONS

The purpose of this enrolment form is to obtain from you the information we need to enrol you into a qualification or course at our
organisation. We also need to collect information from you which is required by government agencies for statistical and registration
reasons. Please fill in the form properly by:
▪ Completing all sections of the form.
▪ Printing your answers clearly in pen, or by ticking the box that applies for multi-choice questions. (Amend as necessary for digital
enrolment process)
▪ Signing the form.
▪ Attaching to the form additional documentation that is required for government funding purposes. A description of the required
documentation is provided on page 6 of the form.

A QUALIFICATION

1 Please tick the qualification you wish  Master of Chinese Medicine Office Use
to enrol in for 2024:  Bachelor of Health Science with major in:
1.  Chinese Medicine (CM)
2.  Acupuncture (Acu)
 Graduate Certificate in Chinese
Medicine (Tuina) - Level 7
 NZ Diploma in Remedial Massage
(Level 6)
 NZ Diploma in Wellness and Relaxation
Massage Level 5
 NZ Certificate in English Level 5
 NZ Certificate in English Level 4

Qualification Start Date: 29 /07/24 Or:

Qualification End Date (if known):

2 Have you studied at NZCCM before? Yes No

3 Do you intend to study: Part time Full time

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4 Please enter the names(s) of the courses you wish to enrol in for 2024:

Or Special Plan

B PERSONAL DETAILS

5 Print your full legal name:

Family Name:

Given Name(s):

6 Preferred first name:

Previous name(s) known by:

7 If you have previously enrolled at this

organisation under another name, what
was that name?

8 Preferred Ms Miss Mrs Mr Other

title: (Specify):

9 Date of birth: 10 Gender: Male

day month year Female
Another Gender

11 If you know your NSN (National Student Number), - -

please write it here.
If you answered Yes to question 2, you MUST fill in
this section.

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 12 Citizenship and Tick the box which best describes your citizenship:
Residency: New Zealand Citizen NZL , go to 12a
Australian Citizen AUS, go to 12a
You may need to supply evidence
of residence or citizenship
Other
If “Other”,
Please specify your Country of Citizenship (For students with dual citizenship,
specify the country of citizenship of the passport used to enter New Zealand.):

Country of Citizenship: _____________________________________

Tick the box if you have New Zealand or Australian Permanent Resident Status:
New Zealand Resident Visa Holder
Australian Permanent Resident

12a During your time studying in this qualification will you be resident in New Zealand
or overseas?
In New Zealand Overseas

12b Please also specify your fee/assistance status.

• Domestic Student* 00
• NZAID Student 01
• International Fee-Paying Student
(including people on current work visa) 03
• Student on a recognised exchange scheme 04
• Foreign Research Based Post-Graduate** 06
• Diplomatic staff or family, or persons 08
associated with Antarctic Programme
• International On-Shore PhD student 09
• International student doing ITO off-job training 12
• Refugee or protected person, yet to be granted a resident visa; 13
the immediate family [1], also without a resident visa, of a person with
refugee or protected person status; and those who have made a claim
to be recognised as a refugee or protected person
• 2021 Resident Visa pathway, children aged 25 years or under 14
on 1 January 2022 and residing in New Zealand, of a person on an
eligible work visa for the 2021 Resident Visa [2]

Note: * Always use 00 for New Zealand Citizen; use 00 for New Zealand resident visa holder and Australian Citizen or
Australian Permanent Resident residing in New Zealand during the time studying this qualification.
** Use 06 for a student enrolled in a programme of study that is:
• A PhD (level 10 on the NZQF); and
• Wholly research (for example, 120-point thesis)
Use 03 for an international student enrolled in a programme of study that is a Masters (Level 9 on the NZQF) or a Doctoral
Programme, excluding PhDs (Level 10 on the NZQF).

1 ‘Immediate family’ is used as defined by the Domestic Tertiary Students Notice (2)(c) as including the partner and any child in New Zealand of
a person recognised as a refugee or protected person, or if the person recognised is a dependent child, their parents and any siblings in
New Zealand. Refer to www.education.govt.nz/our-work/legislation/definition-of-domestic-student/
2 This category of domestic tertiary student will apply for the 2022 and 2023 calendar years only. The specific criteria are outlined in the

Domestic Tertiary Students Notice (2)(j). Refer to www.education.govt.nz/our-work/legislation/definition-of-domestic-student/

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13 Ethnicity: New Zealand European 111 Filipino 411
Māori 211 Cambodian 412
What ethnic group(s) Samoan 311 Vietnamese 413
do you belong to? Cook Islands Maori 321 Other Southeast Asian 414
You may tick up to three boxes, Tongan 331 Chinese 421
which apply to you. Niuean 341 Indian 431
Tokelauan 351 Sri Lankan 441
Fijian 361 Japanese 442
Other Pacific Peoples 371 Korean 443
British and Irish 121 Other Asian 444
Dutch 122 Middle Eastern 511
Greek 123 Latin American 521
Polish 124 African 531
South Slav 125 Other Ethnicity 611
Italian 126 Not Stated 999
German 127
Australian 128
Other European 129

If “Other Pacific Peoples”, “Other European”, “Other Southeast Asian”, "Other

Asian" or "Other” please specify what specific ethnicity below.

14 Iwi:
Iwi:
If you identified as Māori in question 13, Rohe (Iwi home area):
what is the name of your Iwi?
You may enter more than one Iwi. If you do not know your
Iwi, please enter 'Don't Know'. Iwi:
Rohe (Iwi home area):
Note: please use the iwi codes published in SDR Manual
appendices. Iwi:
Rohe (Iwi home area):

15 Prior activity: What was your MAIN activity or occupation in New Zealand at 1 October 2022 – that is
before you began your study. You may tick only one box.
Secondary school student 01 Non-employed or beneficiary (excluding retired) 02
Wage or salary worker 03 Self-employed 04
University student 05 Polytechnic student 06
House-person or retired 08 Overseas (irrespective of occupation) 09
Private Training Establishment student 11 Wānanga student 12

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16 Disability:
Yes No
Do you live with the effects of significant injury, long term illness,
or disability? The information you supply is confidential
The information you supply may be used to offer individual
disability support.
If yes please describe the impairment, disability or long-term
medical condition

I declare the information is correct

Sign -------------------------------------------------

C ACADEMIC INFORMATION

17 Secondary What was the name of the last secondary school you attended? Office Use
School: State “overseas”, if applicable.

What was your last year at secondary school?

What is the highest level of achievement you hold from a secondary school? Your highest
achievement may be a “traditional” award such as School Certificate, or you may have
achieved a number of credits or a National Certificate at a certain level on the National
Qualifications Framework. Your NZQA Record of Achievement shows you the standards,
credits and qualifications you have achieved. Tick only one box.
No formal secondary qualifications 00
14 or more credits at any level 11
NCEA Level 1 or School Certificate 12
NCEA Level 2 or 6th Form Certificate 13
University Entrance 14
NCEA Level 3 or Bursary or Scholarship 15
Overseas qualification (includes International Baccalaureate & Cambridge Exams) 09
Other 98
Not Known 99

Please specify if “Overseas qualification” or “Other”.

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18 Tertiary Study: Will this be the first time you have ever enrolled in a University, Subsidiaries of Te
Pūkenga (Institutes of Technology or Polytechnic), College of Education, Industry
Training Organisation, Government Training Establishment, Private Training
Establishment or Wānanga either in New Zealand or overseas since leaving school? Do
not include enrolments in community classes.
No Yes
If you answered “No”, please enter the name of the organisation you studied at and the
year of your first enrolment:
Name:

Year:

What year do you expect to complete the academic requirements of your course/s in
order to graduate with your qualification?
Year:

19 Prior Please list all of the tertiary qualifications you hold, the month and year you completed
Achievement: each and the tertiary education organisation that it was completed at. Alternatively attach
your academic transcript from the tertiary education organisation and/or a copy of your
NZQA record of achievement.

Tertiary education Qualification Month and year of

organisation completion

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D Agent’s Information
Are you using a student recruitment agent to assist you with this application?
Yes No

If you answered yes to Q 18 please complete the following:

Agent’s Name:

Company Name:

Address:

Phone Number:

Email Address:

E DOCUMENTATION
International students are required to provide each of the following:
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• Passport
• Student visa /Permit
• IELTS/TOEFL score/ ‘other’ (if English is second language)
• Previous Academic Records and qualifications (academic transcript if seeking RPL)
• Travel/medical insurance policy

You must either provide the original documentation OR alternatively please provide a certified copy. This
means a photocopy of your original document, signed as being a true and accurate copy by a Justice of
the Peace (JP), Barrister or Solicitor, Notary Public, Court Register or Deputy Registrar.

21 Please list here all documents

that you have attached to this
enrolment form. Documents
should be securely stapled to
the back of the form.

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F BANK ACCOUNT

22

G CONTACT DETAILS
23 Address and Address: What type of accommodation is this?
Own apartment, flat or house
contact details in
Boarding establishment (e.g. hostel)
New Zealand:
Homestay
Living with designated caregiver
Living with parents
Private board
Post Code:
Temporary (e.g. hotel or motel)

Phone: Alternative Phone:

( )
Mobile: Email:

( )
Fax:
What is your postal address if different from above?

Post Code:

Please note that you are required to notify NZCCM of any change in your contact details or type
of accommodation.
24 Next of kin (if you Name: Relationship:
are under the age Address:
of 18 this should
be your parents):

Post Code:
Phone:
Fax:
Mobile:

Email:

Do they speak English?

Yes No

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25 Name: Relationship:
Emergency
Contact in New
Zealand if
different from next
of kin

Address: Phone:
Fax:
Mobile:

Email:
Do they speak English?
Yes No
26 Phone:
Permanent
address in home
country if different Mobile:
from next of kin
Fax:

Email:

Please Note: It is the student’s responsibility you are required to notify NZCCM of any changes
in your contact details whilst enrolled in the College

ALTERATIONS or CANCELLATIONS

The College reserves the right to:

• Alter the course content, provision, or fees for any course or programme subject to NZQA and
TEC approval.
• Cancel a course or programme due to insufficient enrolment numbers.
• Change subjects delivered in any semester to meet exit qualification requirements.
• Make changes to its policies, procedures and requirements as deemed necessary, subject to
Council and Senior Management approval.

H IMPORTANT INFORMATION

28 Code of Practice NZCCM has agreed to observe and be bound by the The Education (Pastoral Care of Tertairy
and International Learners) Code of Practice 2021 administered by the New Zealand
Qualifications Authority (NZQA). Copies of the Code are available on request from this institution
or from the NZQA website.

29 Immigration Full details of visa and permit requirements, advice on rights to employment in New Zealand while
studying, and reporting requirements are available through Immigration New Zealand, and can be
viewed on their website. www.immigration.govt.nz

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27 Fees and refunds Fees and Refunds
policy details for As per the Education and Training Act 2022, students (International) have the following
International Students entitlements:
The statutory refund period for international students enrolled in courses that are three months or
longer in duration is 10 working days from the day the student is first required to attend. If an
international student withdraws during the refund period, a New Zealand College of Chinese
Medicine is entitled to retain up to 25 per cent of the fees the student pays.
New Zealand College of Chinese Medicine will provide the student with an indication of how the
amount deducted from the refund has been calculated in the process of completing the withdrawal
application.
If the student is unhappy with the amount that New Zealand College of Chinese Medicine has
withheld in the refund, they can lodge a complaint with the NZQA Dispute Resolution Service
through istudent complaints: http//www.istudent.org.nz
For international students enrolled in courses less than three months, the Education Act specifies
two separate refund periods.
For courses of less than five weeks, a student may withdraw up to until the end of the second day
and receive a refund. The student is entitled to receive a refund of at least 50 per cent of any
amount paid.
For courses of five weeks or more, but less than three months, a student may withdraw up to until
the end of the fifth day and receive a refund. The student is entitled to receive a refund of at least
75 per cent of any amount paid.
If the student withdraws after the refund period there is no right to receive a refund.
A full refund of any and all course-related fees paid by students will automatically be given for
programmes which are cancelled by New Zealand College of Chinese Medicine, or which did not
start due to an insufficient number of enrolments.
In the event of a Course Closure Event New Zealand College of Chinese Medicine will refund
students on a pro-rata basis according to the proportion of the undelivered services provided by
the College to the student
New Zealand College of Chinese Medicine reserves the right to cancel any programme for which
there are insufficient enrolments.
New Zealand College of Chinese Medicine staff will ensure all students are fully aware of the early
and voluntary withdrawals and student fees policy. Students should also be notified that
processing of refunds may take up to 2 weeks, or longer where unusual circumstances arise.

28 Eligibility for Health Most international students are not entitled to publicly funded health services while in New
Services Zealand. If you receive medical treatment during your visit, you may be liable for the full costs of
that treatment. Full details on entitlements to publicly-funded health services are available through
the Ministry of Health and can be viewed on their website.

29 Accident Insurance The Accident Compensation Corporation provides accident insurance for all New Zealand citizens,
residents and temporary visitors to New Zealand. International students must ensure this is
covered in their travel and medical insurance.

30 Medical and travel International students must have appropriate and current medical and travel insurance while
insurance studying in New Zealand. NZCCM may assist with appropriate insurance through Southern Cross
travel Insurance (SCTI). You can make contact with SCTI by email at info@scti.c.nz or visit the
website www.scti.co.nz
Students are required to have continuous appropriate medical and travel for the entire period of
enrolment and evidence is required by the College.

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 DECLARATION

Privacy – New Zealand College of Chinese Medicine (NZCCM) collects and stores information from this form to:
• manage the business of NZCCM (including internal reporting, administrative processes and selection of
scholarship and prize winners)
• comply with the requirements of the Education and Training Act 2020 and other legislation[3] relating to
maintenance of records
• supply information to government agencies and other organisations as set out below.

In signing this enrolment form you authorise the disclosure of your personal information on the understanding that
NZCCM will comply with the legal requirements in relation to the use and disclosure of personal information, as set
out in the Privacy Act 2020, the Education and Training Act 2020 and other relevant legislation. You are entitled to
see any information that NZCCM holds about you and request to correct any errors in that information. To do so,
contact the Enrolments Officer.

NB: The Privacy Act 2020 has the stated aim of protecting the privacy of individuals. It also governs the collection,
use, storage, and disclosure of personal information.

The Privacy Act requires NZCCM to collect, hold, handle, use and disclose personal information in accordance with
the twelve information privacy principles in the Act.

https://www.legislation.govt.nz/act/public/2020/0031/latest/LMS23223.html

Supply of information to government agencies and other organisations

NZCCM supplies data collected on this form to government agencies, including:
• the Ministry of Education
• Education New Zealand
• the New Zealand Qualifications Authority
• the Tertiary Education Commission
• the Ministry of Social Development (in relation to student loans and allowances) and Inland Revenue (student
loans)
• Immigration New Zealand (for those who are not New Zealand citizens or permanent residents) and the Ministry
of Business, Innovation and Employment
• agencies which support particular students through scholarships, payment of fees or other awards (if you are a
recipient of one of these awards).
Those agencies use the data collected from NZCCM to:
• administer the tertiary education system, including allocating funding and the administration of the Fees-Free and
Fees-Free Trades Training initiatives
• develop policy advice for government
• conduct statistical analysis and research.

Your personal details (name, date of birth and residency) as entered on this form will be included in the National
Student Index and may be used in an authorised information matching programme with the New Zealand Birth
Register.

The government agencies above may supply data collected on this form to Statistics New Zealand for the purposes of
integrating data with data collected by other government agencies, subject to the provisions of the Statistics Act 1975.
Integrated data is used for the production of official statistics, to inform policy advice to government and for research
purposes.
In handling data supplied by you on this form, the government agencies are required to comply with the provisions of
the Privacy Act 2020.
When required by law, NZCCM releases information to government agencies such as the New Zealand Police,
Department of Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC).
Information collected on this form may be supplied to other educational organisations for the purpose of verifying
academic records.
Fees – In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees
and collection charges associated with debt recovery. NZCCM’s policy on withdrawal and refund of fees may be
obtained from the Student Services Manager.
Rules – In signing this enrolment form you undertake to comply with the published rules and policies of NZCCM
regarding attendance, academic integrity and progress, conduct and use of information systems.

3 This includes legislation governing the maintenance of official records and for accountability for public funding.
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Declaration – I declare that to the best of my knowledge all the information supplied on, and with, this
enrolment form is true and complete, I agree to abide by the conditions described above, and I consent
to the disclosure of personal information as described above.

__________________________________________ _______/_______/_______

Signature Date

➢ Please make sure that you sign your enrolment form above 

Office Use Only

Documentation Approved Entered

___________________________________
____/_____/_____ _____/_____/_____
_____/_____/_____
Principals Approval (Master’s degree only) Selma ID
___________________________________
___________________________________________ Date
____________________________________

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