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.ENROLMENT APPLICATION
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Application for Enrolment
Title
-
Ms
Miss
Mrs
Mr
Dr
Prof
Name
*
Surname
*
Address
*
Suburb
*
Post Code
State
-
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Country
Australia
International
Australian Citizen?
Yes
No
Email
*
Phone
*
Mobile
Date of Birth
Gender
Male
Female
Course to be Enrolled in
Please Choose..
Bachelor Naturopathy
Bachelor Nutritional Medicine
Bachelor Western Herbal Medicine
Bachelor Homoeopathy
Bachelor Mind Body Medicine
-----
Ad Dip Naturopathy
Ad Dip Nutritional Medicine
Ad Dip Western Herbal Medicine
Ad Dip Homoeopathy
Ad Dip Holistic Counselling
Ad Dip Flower Essence Therapy
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Dip Holistic Counselling
Dip Remedial Massage
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Cert IV Holistic Counselling
Cert IV Massage Therapy Practice
Cert IV Aromatherapy
Mode of Study
Online
On Campus
Details of Modules
Please list all the details of the Modules you wish to enrol in this semester.
Module Code eg. AP1
*
Module Name eg. Anantomy & Physiology 1
*
* Details of modules can be found on corresponding course page under "Course modules & year structure in detail" link
Payment Details
Full Payment on acceptance
Payment Plan (registration fee + four (4) monthly payments)
VET FEE-HELP (For eligible Australian students)
Prior Academic Experience
Please give details of your academic background.
ie. Level of study & Qualification eg. Diploma of Nutrition, Institution of study eg. PCNM, Years of study eg.1999-2004
Recognition of Prior Learning
Do you wish to claim Skills Recognition or Credit Transfer for any module(s)/unit(s)
No
Yes
If yes, a request for a RPL/RCC/CT Skills Recognition Form from Administration will be forewarded upon completion of this form
* Please note: Application for Skills Recognition must be made with enrolment and will not be accepted after acceptance into the course (fees apply). If unsure of your personal situation please speak to Paramount College of Natural Medicine for further details
Speial Needs
Do you have any special needs ?
No
Yes
If yes, we will call and discuss these with you in confidence
Declaration
• I hereby certify that the information provided by me is complete and correct. I agree that Paramount College of Natural Medicine (PCNM) may, if necessary verify all details provided including my educational qualifications.
• I acknowledge that Paramount College reserves the right to vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or incomplete information provided by me.
• I am aware that student places at PCNM are determined by their staff and are non-disputable.
Name
*
Date
*
* Denotes a required field
