Northland Connect Registration
This registration form is to be completed by everyone participating in the Northland Connect programme. Applicants may get assistance from their programme provider in completing the form.
IMPORTANT NOTE: Northland Connect is for people who have low or no education qualifications, so please check with your provider that you are eligible before completing this form.
"You" in the questions means "the person registering for the programme".
Date of Birth
Please enter as dd/Mmm/yyyy Example: 24/Jan/1992, 5/Mar/2001 (Month must be one of Jan, Feb, Mar, Apr, May, Jun, Jul, Aug, Sep, Oct, Nov, Dec). Make sure you update the year correctly.
Information we need to contact you and for running the programme.
Please start with area code followed by a space e.g. 04 479 8636
Please start with code followed by a space e.g. 022 192 3326
Postal address 1
Flat / House number, Street name Example: Flat 6, 43 Abbott Street
Postal address 2
Suburb or Rural locality Example: K
City, town or district Example: Whāngārei
Email address (if you have one)
What type of internet connection do you have in your home?
On mobile phone only
Do you have a computer at home that you can use during the programme?
What ethnic group do you identify with?
Cook Islands Māori
Other Pacific peoples
Do you need any help in understanding English?
Level of Education
None, but I attended high school
I have a Level 1 NCEA Certificate or equivalent (School Certificate or NZQA National Certificate Level 1)
I left school without completing NCEA Level 2
Refugee or Migrant
Neither of the above
Any other information you wish to add for this programme. (The box will get bigger as you type.)
20/20 Trust can use stories and/or photos depicting myself and/or my family as Northland Connect participants in the ongoing promotion of the programme.
I do not agree to the use of information or photos of myself and my family.
To take part in the Northland Connect programme, I declare that:
- I have not participated in the Northland Connect programme before
- I will take care of the computer
- I will attend 30 hours training
- I will not open suspicious emails or software which may contain viruses
- I will help make the internet a family activity
- I will ask the Northland Connect team for technical support if the computer is not working
- I agree to be contacted and interviewed for research purposes
- I agree that information about my participation in the programme can be sent to Statistics NZ, the Ministry of Education, Tertiary Education Commission, ACE Aotearoa and other Government agencies where it will be used for research and evaluation purposes only
- I agree to 20/20 Trust utilising group text or email to receive updates on my learning journey.
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