TUPU AOTEAROA
ENROLMENT FORM
Programme for Pacific clients aged 15 years + who are not in Employment, Education or Training (NEET).
Personal Profile
First Name
MIddle name(s)
Surname (Family name)
Preferred name
If different from above
Home Address
Home Phone Number
Mobile Number
Email Address
Date of Birth
DD
/
MM
/
YYYY
Age at Enrolment
Gender
Please select
Female
Male
Diverse
Please select
Details verified by
Select one
Birth certificate
Passport
Drivers License
NZQA Record
Copy of ID document attached
Yes
No
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Pacific Origin
Education Profile
Last Secondary School
Final year at last Secondary School
Highest NCEA Level Achieved
Select one
Nil (none)
Level 1
Level 2
Level 3
NZQA National Student Number (NSN)
Programme Information
Are you currently working
Select one
Yes
No
Are you currently studying
Select one
Yes
No
Have you been referred by Youth Justice or Police
Select one
Yes
No
Have you been referred by Oranga Tamariki
Select one
Yes
No
Receiving an MSD Benefit
Select one
Yes
No
MSD Benefit Number
IRD Number
Emergency Contact Details
Name
Home Address
Home Phone Number
Mobile Number
Email
Enrolment Details
Programme name
Date of enrolment
30
/
03
/
2025
Authority to collect and use information
I
(tick in agreement)
(type your full name)
I acknowledge that I have enrolled in the Tupu Aotearoa Programme delivered by Solomon Group NZ funded by the Ministry for Pacific Peoples (MPP).
I authorise Solomon Group and MPP to collect personal information about me under the Privacy Act 2020 and to retain and use that information for the purposes of delivering services related to the Tupu Aotearoa programme, assisting me to secure placement in employment or further training with any NZQA-accredited training provider, plus monitoring and evaluation of the Tupu Aotearoa programme.
Under the Privacy Act 2020 and the Health Information Privacy Code 2020, I understand that I have a right to access my personal information held by Solomon Group. I also have a right to request correction of any information held by Solomon Group that I think is not correct.
I authorise Solomon Group and MPP to contact my last Secondary School and ascertain my NZQA National Student Number (NSN) and obtain a copy of my NZQA Record of Achievement.
In the event that I am placed in employment by Solomon Group, I authorise Solomon Group, and MPP to approach any employer I have been placed with and confirm details of my employment, including date employment commenced, job title, place of employment, IRD number, starting wages/salary, career-related training provided by the employer, any increases in skills or qualifications, any increases in wages/salary and date (if any) employment ceased.
In the event that I am placed in training with a NZQA-accredited training provider by Solomon Group
I authorise Solomon Group and MPP to approach any NZQA-accredited training provider I have been placed with and confirm date of my enrolment, the course of study undertaken, start and finish dates for the course, the location for the study, the external training provider’s unique student identification number for me, confirmation whether or not: (a) I have continued with the course of study for 31 days after the course commencement date, (b) I am continuing with the course of study at the time of enquiry,(c) I have completed the course of study or (d) I have achieved any qualification or been awarded any Certificate in relation to the course of study.
For clients who are under 18, a separate consent form will need to be signed by a parent/caregiver and attached to this form.
For clients who are under 18, the separate consent form has been signed by caregiver and is attached in file.
Date
30
/
03
/
2025
Verification
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