Please advise what your health condition is AND
-if you are taking medication for it
-if you are receiving regular support from a health or social service
Media Consent
We may capture photographs or other media content during programme activities and events. These may be utilise in publications ( including social media, website and reports)
Are you willing to grant permission for your photo, video and korero to be captured and utilised for these purposes.
Evaluation Consent
To maintain the quality of our programmes, Te Hiku Hauora will complete regular evaluations and will invite you to participant in a range of evaluation activities. Any feedback remains confidential and no names are disclosed in the evaluation reports. We would appreciate your participant in these evaluations to help us shape Te Hiku Pae Tawhiti for future participants. Are you interested in being part of this process?
Privacy Declaration
We care about your privacy and want you to be familiar with the information we collect, use and disclose. By enrolling in Te Hiku Pae Tawhiti you agree to the following terms:
I understand that the information I provide to Te Hiku Pae Tawhiti is being provided voluntarily and for the purpose of providing me with a Ministry of Social Development (MSD) funded Work Readiness service. If I choose not to provide the information identified as being required for enrolment, I understand that I may be unable to participate in the Programme.
My information will be held by Te Hiku Hauora – Te Hiku Pae Tawhiti Programme and I understand that under the Privacy Act 2020 I have the right to access and correct any information that Te Hiku Pae Tawhiti Programme may hold about me.
I agree that Te Hiku Pae Tawhiti may contact organisations or MSD on my behalf for the purpose of providing me with their services, and that those same organisations may provide information that they hold about me for that same purpose.
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Some of my information held by Te Hiku Pae Tawhiti will be provided to MSD where this is required for the purposes of programme administration and the reporting of data. MSD may share information on my circumstances with Te Hiku Pae Tawhiti to aid in eligibility determination and to enable programme service delivery. If I require further information about how MSD will manage my personal information, I understand that I am able to find this on MSD’s webpage under Privacy Notice.
I understand I can withdraw from the programme in which I am enrolled at any stage by notifying Te Hiku Pae Tawhiti Programme and that some of my information will need to be retained for reporting purposes.
I understand that I have a right to complain to the Privacy Commissioner if I am concerned about how my personal information is being used or protected.
I confirm that the information I have provided is true and correct and that I have read and understand the privacy statement and declaration.*
Kia ora - thank you for submitting your application. We will be in touch soon!