Grandfathering Pathway

Personal Details

Name*

Prefix First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mobile Phone*

Phone

Email

Position

Organisation

Employment Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Accreditation Level*

Please tick the LEVEL(s) you are applying for accreditation in:

Speciality Details

Please tick your primary, and if applicable secondary speciality areas that you have acquired hours for level 2

Qualification

Major

Institution

Year completed (expected)

Verified Academic Transcript

Drop files here or

First Aid and CPR certificates

Drop files here or

Tick to accept*

I declare the information I have provided in support of this application is a true and correct reflection of my qualifications, education and experiences. I agree to abide by the SESNZ Code of Ethics.

Tick to accept*

Privacy Policy*

I consent to the collection of my contact address and personal details by Sport and Exercise Science New Zealand for the purposes of assisting the development of Sport and Exercise Science New Zealand and for it to retain, use and disclose this information to its officers and members for this purpose. I acknowledge my right to have access to and correct this information under the Privacy Act 1993.