2026 Enrolment Form

Please ensure you have read the eligibility criteria before completing the application form.

Personal Details

First Name *

Last Name *

Gender *

FemaleMaleOther

Email Address *

Work Phone

Home Phone

Mobile

Your information

What region is the closest to where you will be working? *

What is your highest completed qualification? *

MastersPhDPostgraduate Diploma

What is your FTE in this area of practice? *

NCNZ Registration Number *

Employer/Place of Employment *

Area/town/city you provide your clinical service to

PHO (if known/relevant)

Have you completed three years (within the last five years) in this area of practice? *

YesNo

Do you work rurally? *

YesNoSemi-rurally

Academic Institution you are currently enrolled or intending to enrol with *

Please upload your CV *

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Letter of application *

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Create a cover letter word doc outlining why you want to take part in this programme and upload it here

Teaching professional activities and leadership tables *

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Download the table here, complete it and save it to your computer then upload the completed table.

Section B: Clinical supervisor information

This section is for you to input information about your clinical supervisor.

Supervisor CV *

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Your supervisor's name *

Your supervisor's position *

Your supervisor's MCNZ or NPNZ Provider Number *

Your supervisor's mobile phone *

Your supervisor's email address *

Upload clinical supervisor letter of agreement

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Download the clinical supervisor letter of agreement here, complete it, and save it to your computer. Then upload the completed letter.

Section C: Referee information

Contact details of a senior health professional (ideally a Nurse Practitioner, or alternatively one of the following - nurse leader, senior general practitioner) who we can contact as a referee for your readiness to complete the NP Programme.

Referee's Name *

Referee's position *

Referee's email address *

Referee's mobile number *

Section D: Employer information

Employer name *

As an employer will you employ the NP upon registration? *

YesNoWould like to employ, but can not confirm at this time

Upload the declaration completed by your employer *

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Download the Employer Declaration of Support Template here, ask your employer to complete then upload here.

Section E: Submitting your application

Review our NPTSS application checklist here to check you have completed everything you need to.

By submitting this form, I declare that all information enclosed and attached to my application form is true and correct and that no relevant information has been withheld. *

I understand that my information will be shared with a tertiary provider to confirm my enrollment *

Please note you may be required to attend an interview over Teams.