PDP Application

CBS Peer Development Programme - Application Form

* Indicates required field

Are you completing this application personally? *

Yes No

Name of person you are completing this application on behalf of: *

Applicant's Name *

First

Last

Applicant's Email *

Applicant's Phone Number *

Applicant's Current Residnetial Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you legally entitled to undertake voluntary study and work in New Zealand? *

Yes No

How can we support you if you are accepted on to our PDP programme? *

Interpreter Adaptive Equipment Wheelchair access Health conditions

If you have ticked you require any of our support options please explain in more detail how we can help: *

Declaration *

If you have a declaration, please explain it in more details: *

Consent *

Please write a short, relevant personal statement about you and your interest in becoming a Lactation Consultant *

If you do not consent, please explain why: *