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Select Programme *
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STUDENT INFO
First Name *
Last Name *
Date of Birth *
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/
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/
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Current Age *
Gender *
Ethnicity *
Required
Do you whakapapa to Ngāti Whakaue? *
If you are Māori, what is your hapū/iwi?
Residency Status
 *
EMERGENCY CONTACT
Emergency Contact Name 
 *
Relationship to Student 
 *
Emergency Contact Email
 *
Emergency Contact Mobile 
 *
Do you have a disability or health condition? 
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If your disability or health condition impacts on your time with us - please let us know if you wish too.
HEALTH & WELLBEING
Disability/Health: If yes please provide more details:
All information is kept confidential.
Do you have any allergies? *
Allergies: If yes please detail what they are:
Are you currently seeing a counsellor/psychologist/psychiatrist? 
Only answer if you are enrolling in our 20 week courses or if you want to share.
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CONTACT INFORMATION
Student Mobile
 *
If student is under 13 please use parent/caregivers mobile.
Student Email
 *
If student is under 16 please use parent/caregivers email.
Street Address
 *
Suburb *
Postcode *
Town/City *
ACADEMIC INFORMATION
Are you currently enrolled in a Course/Programme/School *
Last School Attended / Most Recent or Current Education Provider *
If you are with Te Hiringa, Kōkiri or Awhina, just let us know which you are currently enrolled)
What was your last year of Secondary School?

For those taking our Native Tech programme
Highest level you hold from Secondary School? *
Just tell us the highest level you have completed.
What were you doing 3 months ago? *
Tick all those that apply.
Required
Literacy: What levels have you completed?
Tick all those that apply. Only if you are enrolling in Native Tech 20 week programme.
Numeracy: What levels have you completed?
Tick all those that apply. Only if you are enrolling in Native Tech 20 week programme.
INTERESTS
Tick all that apply and add your own :) *
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What games do you like to play? *
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Why are you applying to enroll at DNA/Native Tech?
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How did you hear about us?
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Please tell us how you heard about us, tick as many as apply.
Anything else you'd like to add? *
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This form was created inside of Native Institute of Digital & Creative Technology .