Mahi Gains Accelerator Registration Form
Please complete the registration form below
Date of Birth*
Prefer not to say
Not currently involved in education or employment
Please provide details for your preferred form of contact for Mahi Gains?*
Emergency Contact Details*
Are you involved with any agency?
Work and Income
Do you have any health issues that we should be aware of? (Please tick options below)*
If you answered other please provide details below
If you ticked yes to any of the boxes above please let us know if you require medication for this
Do you hold any current form of identification?
NZ Drivers Licence
Which short course would you like to complete on the programme?
Full Drivers Licence
If you answered other, please provide details below
What is your dream job?*
What are you hoping to achieve during the Mahi Gains programme?*
How did you hear about us?*
Please verify your request*