Sorted Kāinga Ora | Tūwharetoa Settlement Trust

ENROLMENT Form

Sorted Kāinga Ora is designed to help whānau navigate their goals of Homeownership.

To ensure this programme is right for you, please complete all boxes below before clicking submit.

First Name *

Last Name *

Street Address

City *

Email Address *

Phone *

Signature

Submitting and authorising I have read the Privacy Statement. I understand that by submitting this form I am authorising Te Puni Kōkiri and He Iwi Kāinga to collect, hold and disclose information as described in this Privacy Statement.

How many adults (aged 16+) including yourself live in your whare? *

How many children (aged 0-15years) live in your whare? *

How many bedrooms does your whare have? *

What is your current housing situation?

What is your main source of income? (please select one only)

How much do you pay for accommodation (rent/ mortgage) each week?

Do you have money saved (including Kiwisaver)?

What is the main thing you want to achieve from this course? (Please select one only)

By signing this form, I acknowledge and understand the information will be given to me and I am aware that I can clarify any aspect of my consent at any time. This consent will be reviewed annually or at any time at my request. I acknowledge that staff working with me and others who are involved in my plan or programme may need to share health information to ensure I receive a quality service. I acknowledge that staff will only share my information with other services, as necessary. *