HEI WHAKAPIKI MAURI INFORMATION FORM

ABOUT YOU AND YOUR WHĀNAU

We’d love to get to know you a little so that we can work with you and your whānau in the best way possible. Fill out as much of this form as you can and then hit 'submit'.

Navigator Suzi can help you fill this out if you want her to.

CONTACT SUZI

Email: suzi@kanohikitekanohi.org
Call/text: 021 435 960

If you would prefer to fill out a paper form with whānau, you can download the form here.

Please complete the form below

Name

First Name

Last Name

Date of Birth

YYYY

Email Address

Phone

(###)

###

####

Home Address

How would you like to be contacted?

Iwi

Hapū

Gender

Who is in your whānau

Help us understand who those close to you are.

What are the most important things to you / and your whānau right now?

What could be better?

What support would make the most difference to you / and your whānau?

Which areas or pou would you / your whānau like to work on with Hei Whakapiki Mauri? *

Your identity and te ao Māori

Connecting to your hapū and turangawaewae

Having information and resources on disability supports and funding

Building supports and networks

Whānau Survey

WE COLLECT THIS INFORMATION TO HELP DESIGN FUTURE PROJECTS FOR WHĀNAU.

How much te reo Māori do you speak?

Your highest qualification:

Your employment status:

Sign Off

Name of person filling out form

Relationship to disabled person:

(if completing form on behalf of whānau)

WHAT HAPPENS NEXT?

Kaiwhakahaere Ruth Jones looks forward to talking with you and your whānau about Hei Whakapiki Mauri, what you want to achieve and how we can work together.