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RĀNGAI ENGAGEMENT FORM

Gender
Ethnicity
Highest Qualification Achieved
Have you ever experienced expulsions or stand-downs from school, or been asked to leave?
Are you currently in employment, education and/or training?
In the past 12 months how many months have you NOT been in employment education or training
Are you currently recieving any type of WINZ support / MSD Benefit ?
Current Drivers Licence
Do you have any dependents ?
Do you have any criminal convictions ?
Did you become unemployed, or leave school or training because of COVID-19 ?

Rāngai is funded by the Ministry of Social Development (MSD). As part of our funding agreement, we are required to provide anonymous demographic data about participants in our programmes to MSD. The data is used for monitoring and research purposes.

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I consent to the information above being shared with the Ministry of Social Development.

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I understand that my name, or any other personally identifiable information, will not be shared.

Parent/guardian if under 18)

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