Student Introduction Day Application Form Please use legal name(s) as shown on your Birth CertificateFirst Name(s)*Surname*Gender*MaleFemaleDate 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.Section BreakParent/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?*YesNoSection BreakSecondary School Details at Time of RegistrationName of Secondary School *If you are no longer a Secondary student, please write ADULT STUDENT.*SuburbPostcodeCitySchool Contact Person*School Contact NumberEmail* Do you have permission from your school to attend?YesNoSchool Year*Year 12Year 13OtherPlease 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?*YesNoWhat 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- AchievedSection BreakCareer DetailsWhat 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*Section BreakProgramme InformationHow did you hear about the Rangatahi Programme? Please SelectCareers AdvisorsTeacherFriends/WhanauWhakapiki AkeOtherPlease 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*NoYesAuckland 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.CAPTCHA
