1. Please fill in your personal details
Please allocate 30 minutes to fill in this application. Ideally have a CV that you can upload (though not essential). Let the real you shine through, as we'll draw on your responses when deciding the KEP cohorts.
We are recruiting for programmes in Auckland and East Coast (Tai Rawhiti + Takitimu) - both programmes running May-August, part time.

If you're going to take several sittings to complete this form, copy these long answer questions into a Word document and answer them there, then copy them back here to submit this form.

= I am attracted to the 'Ka Eke Poutama' programme and keen to participate because...
= The sorts of things that I am most keen to learn about and experience on the programme over the next 4 months are?.. (don't write "governance". If you need to, refer to the brochure for what we cover)
= The sorts of things I'd like to contribute to my community over the next 12 months are...
= The ways that I would like to be involved in governance and social enterprise include...
= Other ways that I plan to apply the learning (around governance, leadership, social enterprise, innovation, strategy) and make a difference are...
= Are there any other barriers that may prevent you from putting in full effort for Ka Eke Poutama, or things you'd like us to be aware of?

My full name is... *
My age is... *
My email address is... *
My mobile number is... *
My Facebook page link is... (or write "none") *
My Linkedin profile is... (if you have one)
My current work status is...
The region I live in is... *
The town/suburb I live in now is... *
I grew up in the town/suburb of... (can list several) *
I heard about this Ka Eke Poutama programme from... *
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