Register your interest here for KiwiMANA

How did you find out about the kiwiMANA programme? Check all that apply.
FacebookInstagramSomeone told me about itI know someone who has done itI saw it in the papersI saw it onlineI heard about it on the radioI received an emailBald Angels newslettersOther

Who are you?
A youth wanting to Step Up and learn new life skills?A social worker wanting to refer potential candidates?A parent or caregiver wanting to refer someone?A teacher wanting to refer someone?A potential employer offering work experience opportunities?A provider offering services?OtherJust wanting more information(Please check our Q&A's first)

Please answer the following questions:
What is their Birth date (required)

Their Current Age (required)

Their Gender (required)

Are they unemployed?
YesNo
Are they in education?
YesNo

Where & What Level? (required)

Are they registered with WINZ (MSD)?
YesNo

What is their client number? (required)
Note: Their MSD client number will be on some correspondence with WINZ

I don't know their client number
Their case manager’s name? (required)

Their WINZ office location (required)

Are they capable of applying themselves?
YesNo

Please explain why you are applying on their behalf (required)

Name of Agency / School (required)

Your Position

WORK Phone (required)

Address (required)