Student Introduction Day Application Form

Please use legal name(s) as shown on your Birth Certificate
First Name(s)*
Surname*
Gender*
- Male
- Female
Date of birth*
Please state Iwi or Pacific Nation you identify with*
Email*
Phone*
2021 Introduction Days*
- Select All
- Thursday 20th May
- Thursday 3rd June
- Thursday 2nd September
Please choose which introduction day/s you are available to attend. All 2021 introduction days have the same content and we adhere to try and place you with your preferred day.
2021 Introduction Days*
- Select All
- Thursday 3rd June
- Thursday 2nd September
Please choose which introduction day/s you are available to attend. All 2021 introduction days have the same content and we adhere to try and place you with your preferred day.
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Parent/Caregiver/Emergency Contact Details
(1) Name*
Relationship to you*
Landline Phone No.
Mobile No.*
Email*
(2) Name*
Relationship to you*
Landline Phone No.
Mobile No.*
Email*
Are your Parents/Caregivers aware of your intent to attend the Rangatahi Introduction Day?*
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Secondary School Details at Time of Registration
Name of Secondary School *If you are no longer a Secondary student, please write ADULT STUDENT.*
Suburb
Postcode
City
School Contact Person*
School Contact Number
Email*
Do you have permission from your school to attend?
- Yes
- No
School Year*
- Year 12
- Year 13
- Other
Please specify. Note: This programme does not currently cater to students below Year 12, but school leavers may be accepted.*
What Subjects are you taking? (please tick all that apply) Note: It is important that you give us as much information as possible about your subject choice, in order for us to assist you with your career pathway.*
- General Science
- Biology
- Chemistry
- Physics
- Maths
- English
- IT / Computer Class
Are you in a Gateway Programme?*
- Yes
- No
What other subjects are you currently taking?
What qualifications do you currently have (e.g. NCEA L1, L2, L3, UE)?
What grades did you achieve in each subject in your most recent qualification? E.g. Y12 English- Achieved
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Career Details
What health careers are you interested in? Most Popular choices
- Nursing
- Midwifery
- Physiotherapy
- Medicine
- Occupational Therapy
- Pharmacy
- Podiatry
- Radiography
- Technician (e.g Renal, Anaesthetic)
- Laboratory
- Social Work
- Dietician
- Mental Health
- Other
Please specify*
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Programme Information
How did you hear about the Rangatahi Programme? Please Select
- Careers Advisors
- Teacher
- Friends/Whanau
- Whakapiki Ake
- Other
Please specify*
Photos are taken as a part of Introduction Day and are displayed on both our website and Facebook page. Please tick here if you consent to your image being apart of our gallery*
- No
- Yes
Auckland District Health Board assures all applicants to the Rangatahi Programme that the information you give us will remain totally confidential to the Programme and will not be made available to anyone outside the administration of the Programme under any circumstances.
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Website by: Ascona

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Parent/Caregiver/Emergency Contact Details

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Secondary School Details at Time of Registration

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Career Details

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Programme Information