Maori interested in a Rangatahi into Governance programme

Nomination information

1. Mauri ora!

Nominations for the 2017 Ka Eke Poutama 101b programme closes at midnight 21st August.

If you miss this cut off and are interested in nominating someone for future rangatahi programmes please complete this form.

Your nomination will be strongly considered as part of their application.

If you share the nominee's contact details, we can liaise with them around our standard application process we will be undertaking. *This question is required.

Nominee's full name
Nominee's email address
Nominee's mobile number
Nominee's other contact info (e.g. Facebook)
Suburb nominee lives in (if known)
Nominee's iwi connection
Nominee's marae connection (if known)

2. What draws you to nominate this particular person? *This question is required.

3. Please tick which of the below your organisation can agree to..
Note these are not essential to make the nomination.

Our organisation could likely contribute $1,200 (part-fund Auckland based participants) participation in the 4 month programme if they are selected
Our organisation could likely allow this nominee to observe 1-2 of our governance meetings as part of the programme experience
Our organisation could likely create an 'associate trustee' or 'full trustee' role for the nominee if they successfully complete the programme
Our organisation could likely contribute $2,300 (part-fund outside of Auckland based participants) towards the nominee's

4. Please provide your details so we can confirm where the nomination came from: *This question is required.

Your name
Your organisation
Your role title
Mobile number or email address
Any other relevant info

5. Note any other comments or questions you have for us.. and our team will email or call you back.

6. Any recommendations on improving this signup form? Tuhia mai..

'Ka Eke Poutama' Programme - Participant Nomination

Nomination information