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| Course Application
Form |
| First Name: * |
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| Last Name: * |
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| Date of Birth: |
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| Age: |
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| Gender: |
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| Address Line 1: |
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| Address Line 2: |
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| City: |
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| State: |
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| Country: * |
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| Post Code: |
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| Contact Phone: |
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| Mobile / Cell: |
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| Email: * |
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| New Zealand citizen or resident: |
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| Nationality: |
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| Current Occupation: |
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| Educational Qualification: |
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| Please describe any
past experience relevant to Homeopathy: |
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| Briefly state your reasons
for wanting to study homeopathy: |
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| Courses for which
you are applying |
| ESSENCE, Certificate in Homeopathic Acute Prescribing (1 Year, NZQA Level 5) |
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| EVOLUTION, ACCH Diploma
in Homeopathy (4 Years, NZQA Level 7) |
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| Medical Science Course (NZQA Level 5) |
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| Senior Seminar Program |
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| Do
you wish to study via our Distance / Flexible Study Option? |
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| I am going to fund the course
by: |
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| Self funded |
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| Student loan (NZ citizens
/ residents only) |
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| Training
Incentive Allowance (WINZ) |
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| Where did
you hear about the ACCH? |
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| Please add me
to ACCH's mailing list to receive our newsletters / related
info. |
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