Affordable Rentals Form

Please complete the form below to register your interest in future affordable rental homes.

Under the Privacy Act 2020, you have the right to ask for a copy of all information held about you and have the right to request the correction of any incorrect information.

First name(s)

Last name

Gender Wahine/FemaleTāne/MaleIra Whiti/Gender Diverse

Date of Birth

Email address

Relationship Status SingleDivorcedMarriedCivil UnionWith a long term partnerI'd rather not say

Phone number

Address

How long have you lived at this address?

Please share more about why you are leaving this address

Please tell us about yourself

Registered with TST? Yes No Unsure

Languages spoken Te Reo Māori English He reo anō/Other

Tūwharetoa Settlement Trust works with these hapū

Please state your hapū and marae affiliations.

Your hapū Ngāti Hikairo ki Tongariro Ngāti Turangitukua Ngāti Manunui Ngāti Hinemihi Ngāti Hine Ngāti Rauhoto Ngāti Rauhoto-a-tia Ngāti Haa Ngāti Moekino Ngāti Te Kohera Ngāti Tarakaiahi Ngāti Wairangi Ngāti Te Urunga Ngāti Parekaawa Ngāti Rongomai Ngāti Te Rangiita Ngāti Ruingarangi Ngāti Waewae Ngāti Kurauia Ngāti Tutetawhā Ngāti Wheoro Ngāti Turumakina Ngāti Hineure Ngāti Tutemohuta Ngāti Te Maunga Ngāti Whitikaupeka Ngāti Whitikaupeke Unsure

Your marae Hikairo (Te Rena) Hirangi Kakahi Kauriki Korohe Maniaiti Maroanui Moawhango Mokai Nukuhau Ōngāroto Opaea Oruanui Otukou Pakira Papakai Petania Poukura Pukawa Rongomai Te Mahau Te Rangiita Tokaanu Te Tikanga (Tokorangi) Tutetawha Waihaha Waihi Waipahihi Waitetoko Whanganui Bay

Please tell us about your whānau.

Employment Status EmployedBenefitACCPension

How many adults in your houshold? 1 2-4 5-7 8-10 11+

How many children in your houshold? 1 2-4 5-7 8-10 11+

Any pets in your household? I have a guide dogI have a disability assist dogI have a catI have a dogI have a birdI have something else

WHAT CATEGORY BEST DESCRIBES YOUR GROSS (BEFORE TAX) FAMILY INCOME DURING THE LAST 12 MONTHS? Less than $10,000 $10,000-$24,999 $25,000-$49,999 $50,000-$64,999 $65,000-$74,999 $75,000-$99,000 $100,000 or more

What sort of home are you looking for? 1-2 bedrooms3-5 bedrooms6+ bedrooms

Emergency Contact

First name(s)

Last name

Phone number

Relationship to you Matua/ParentHoa Pūmau/Spouse/PartnerTamaiti/ChildHoa Pai/FriendKaiāwhina Matua/POA

Tell us more about your living situation

Specific Needs/Considerations

Safety Risks/Concerns