MPhysioPrac supplementary application form

Applications close 1 October 2023

Please read the MPhysioPrac information for applicants in the PDF below:

MPhysioPrac information for applicants. Size: 266.1 kB. Type: PDF.

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Section 1 - Personal details

Full name:

Preferred name:

Your University of Auckland ID number, if you have one:

Email address:

Phone number:

Gender identification:

Citizenship/residency status:

Ethnic identity:

Section 2 - Qualification details

Please give details of your completed university qualification(s):

If you are currently studying, you can type this in the field below.

Qualification 1:

Name of degree and major/specialisation:

Year completed:

Name of university:

Name of country:

Qualification 2:

Name of degree and major/specialisation:

Year completed:

Name of university:

Name of country:

Qualification 3:

Name of degree and major/specialisation:

Year completed:

Name of university:

Name of country:

Upload your most recent academic transcript:

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Section 3 - Work experience

List any work experience which you think is relevant to physiotherapy:

Year(s) employed (role 1):

Employer name, position and description of duties (role 1):

Year(s) employed (role 2):

Employer name, position and description of duties (role 2):

Year(s) employed (role 3):

Employer name, position and description of duties (role 3):

Year(s) employed (role 4):

Employer name, position and description of duties (role 4):

Year(s) employed (role 5):

Employer name, position and description of duties (role 5):

Section 4 - Enrolment details

You intend to enrol:

Full time Part time

Section 5 - Background details

Please note that you should be prepared to discuss your answers to the questions in this section during the interview process.

How did your interest in physiotherapy begin?

Identify those personal qualities and academic abilities that would likely help you become a qualified physiotherapist.

What are your major areas for improvement and future development?

Have you acted violently towards another person?

Yes No

Do you currently have, or have had, problems associated with alcohol or drug use?

Yes No

Do you currently have, or have you had, problems with health or well-being (physical and/or psychological) that may impact your ability to train and/or work as a physiotherapist?

Yes No

Have you ever been convicted of an offence?

Yes No

Have complaints ever been made about your practice in previous employment (paid or unpaid)?

Yes No

What were your reasons for leaving your previous job(s)?

Section 6 - Prerequisite study requirements

Note that if your studies of anatomy, physiology, exercise physiology and neuroscience were taught in combined units, then you must have completed at least 4 units of study to cover these areas.
A unit of study (also called a subject) is equivalent to 40 hours of face-to-face class time delivered at a bachelor’s degree level or higher.
All units must have been studied at university level and completed within the last 10 years.
Unit subject codes and names can vary across institutions. An example from the University of Auckland is EXERSCI 304 Sport Psychology.

Download and complete the prequisite study form:

Prerequisite study form. Size: 110.1 kB. Type: DOC.

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Section 7 - Police vetting consent form

Download and complete the police vetting consent form:

MPhysioPrac police vetting consent form. Size: 308.6 kB. Type: PDF.

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Upload your completed police vetting consent form here:

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Section 8 - Immunisation programme consent form

Download and complete the MPhysioPrac immunisation programme consent form:

MPhysioPrac immunisation programme consent form. Size: 318.3 kB. Type: PDF.

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Upload your completed immunisation programme consent form here:

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Section 9 - Declarations

By submitting this form, you:

agree to have audio/visual recordings taken of you during classroom and clinical activities for teaching and assessment purposes.

agree to undertake a clinical placement outside of Auckland if required.

agree to have any immunisations necessary for you to undertake required courses and to provide a copy of the results of the infectious disease screening procedure to the Programme Director before you commence the MPhysioPrac degree programme.

agree to undertake a police history check on request.

acknowledge that your application is unlikely to proceed if statements you have made above are found to be false or inaccurate.

Please make sure you have completed all forms correctly and uploaded them before clicking 'Submit'.