2027 Application Form

Prior to completing this application, please review the eligibility criteria and the application checklist. These resources will help ensure you are eligible and have completed all requirements before submitting your application.

Personal Details

First Name *

Last Name *

Gender *

FemaleMaleOtherPrefer not to say

Mobile *

Email Address *

Your information

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

What is your highest completed qualification? *

Postgraduate DiplomaMastersPhD

Have you previously enrolled in a Nurse Practitioner practicum or equivalent *

YesNo

Please provide name of Education Provider *

Programme/Course Name *

Years of enrolment *

Indicate the outcome of your enrolment *

Withdrew prior to completionDid not successfully complete (failed)Other

Please specify *

You may provide any additional information you would like the admissions panel to consider

What is your FTE in this area of practice? *

NCNZ Registration Number *

Are you employed by Health New Zealand | Te Whatu Ora *

YesNo

Download the acknowledgement of application form,

Ask your Director of Nursing (or equivalent) to review and sign it and then upload the completed document.

Upload the acknowledgement of application form *

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Employer/Place of Employment *

PHO (if known/relevant)

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

YesNo

Do you work rurally? *

YesSemi-rurallyNo

Tertiary Education Provider (TEP) you are currently enrolled or intending to enrol with *

If you have already completed a Master of Nursing, indicate if you have a second preference of TEP

Upload your relevant academic transcript *

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Upload your CV *

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this must include your FTE and demonstrate adequate relevant clinical practice experience

Upload your letter of application *

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suggestions for what to include in your letter is available on the application checklist

Download the Teaching, Leadership and Professional Development tables and review the Philosophical Statement instructions. Once complete, upload both below.

Upload teaching, leadership & professional development tables *

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Upload your area of practice and philosophical statement *

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Section B: Clinical Supervisor information

Your supervisor's name *

Your supervisor's MCNZ/NPNZ registration number *

Your supervisor's position *

Your supervisor's email address *

Your supervisor's mobile phone *

Download the Clinical Supervisor letter of agreement, ask your supervisor to complete it, then upload the completed document.

Upload clinical supervisor letter of agreement *

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If your Clinical Supervisor does not have a recent CV, download this alternate form and ask them to complete it then upload here.

Upload clinical supervisor CV or alternate form *

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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.

Note, your referee and clinical supervisor can be the same person.

Referee's Name *

Referee's position *

Referee's email address *

Referee's mobile number *

Section D: Employer information

Employer name *

Download the employer letter of support, ask your employer to complete then upload the completed document.

Upload employer letter of support *

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Section E: Submitting your application

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 Tertiary Education Providers to process my application *

Please note you may be required to attend an interview over Teams with your nominated Tertiary Education Provider as part of the application process.

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Privacy notice

NPTSS collects the personal information you provide in this form to assess and process your application to the Nurse Practitioner Training Programme Practicum and Support Scheme, communicate with you about your application, and administer the scheme.

Providing this information is necessary for us to assess your application. If you do not provide the requested information, we may be unable to process your application. To support these purposes, we will share relevant information with your nominated Tertiary Education Provider (TEP). To support and streamline application assessment, we will share your name and nominated TEP preference with all participating TEPs.

We store your personal information securely and retain it only for as long as necessary to fulfil these purposes, meet our legal obligations, and maintain scheme records. If your application is successful, we will retain your information for the duration of your participation in the Support Scheme and any required record-keeping period afterwards.

You have the right to request access to, and correction of, your information. To do so, or if you have any questions about this notice, please contact NPTSS at info@npsupport.co.nz

For more detail, see our full Privacy Policy