PAPAKĀINGA HOUSING EXPRESSION OF INTEREST

Applicant Details *

Applicant 1 (Primary)

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Check all that you belong to: *

Applicant 1

Ngāti Rārua and Te Ātiawa ki Motueka

Wakatū Incorporation and you whakapapa to those original tupuna (the 254) identified by the Native Land Court in 1892 and listed on the 1892 list of original owners

Te Rūnanga o Ngāti Rārua – registered member

Te Ātiawa o Te Waka-a-Māui – registered member

Ngāti Tama ki te Waipounamu Trust – registered member

Ngāti Koata Trust – registered member

Te Rūnanga o Toa Rangatira – registered member

Te Rūnanga a Rangitāne o Wairau - registered member

Ngāti Apa ki te Rā Tō Trust - registered member

Ngāti Kuia - registered member

Tangata Tiriti / Community Member

Mataa Waka*

Do you have dependents *

(i.e. who either live with you or who you support financially?)

Yes

No

What is your current address? *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Current living arrangements *

Rent

Own house

Boarding

Living with family

Other

What size whare would you like to be considered for? *

Two bedroom

Three bedroom

Four bedroom

Any health or disability issues / barriers that you would like to share with us *

Yes

No

Are you or anyone who will be living in the whare registered on the MSD Public / Social Housing register? *

Yes

No

If you are not registered on the MSD Public / Social Housing register, are you open to meeting with a representative from MSD to discuss if this is an option?

Yes

No

Do you currently do any activities that contribute to Te Āwhina Marae and our iwi / hapū entities ? *

Yes

No

Is Te Reo Māori spoken in your home? If yes, please indicate the percentage of general conversation that occurs in Te Reo Māori

Yes

No

10%

25%

40%

50%

>50%

Do you consent to Te Āwhina marae: *

Obtaining a credit check for you

Yes

No

Do you consent to Te Āwhina Marae: *

Obtaining a police check for you

Yes

No

Name of Referee *

Referee 1

First Name

Last Name

Contact phone number: *

(###)

###

####

Name of Referee *

Referee 2

First Name

Last Name

Contact phone number: *

(###)

###

####

Applicant 1 *

First Name

Last Name

Declaration *

I agree that the answers to the questions given above are true and correct as at the date of this Expression of Interest Application