Rangatahi Application Form
Hawea Vercoe Leadership Programme
Name
*
First Name
Last Name
Date of Birth
*
Gender
*
Current Year in School or University
Name of School or University
Do you whakapapa back to, live in or come from any of the listed locations?
*
Far North
Auckland
Hamilton
Gisborne
Rotorua
Wellington
Christchurch
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile Phone Number
*
-
Area Code
Phone Number
Home Phone Numebr
-
Area Code
Phone Number
Email
*
example@example.com
Parental/ Caregiver Consent
For those under the age of 18 years.
Name of Parent/Caregiver
First Name
Last Name
Relationship to child
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Signature
About the Rangatahi
Please complete the below information as best as you can.
Tell us which Iwi and Hapa you below to.
In 20 words, describe your best qualities.
Tell us what you are most passionate about as a young person?
What are your current interest and goals and what are you doing to work towards them?
Have you ever participated in a mentoring programme before? (Either as a mentor or mentee?)
If you were Prime Minister, what are the top three things you would want to change or implement? and Why?
Who is someone you look up to for inspiration?
Submit
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