Register

Account details

Email*

Password*

Confirm Password*

Alternative email

Personal information

First Name*

Last Name*

Mobile*

Phone

Date of birth

Gender

Ethnicity

Can you speak te reo Māori?

Would you like to receive our newsletter?

Are you on Facebook?

Home address

Street

Suburb

City

Postcode

Career choices

Career Choice 1

Career Choice 2

Career Choice 3

Education

Current education status

I have selected a health pathway

Year of study

City

School

Year level

Current science subjects

Would you like to have a mentor?

I have applied for a health related tertiary course of study

I am motivated to pursue a health career

Year of study

City

Institute

Year level

Programme or degree

Major

I have applied for scholarships

Would you like to have a mentor?

Would you like to be a mentor?

Highest education

Major

Year completed

Are you currently employed?

Terms & conditions

Would you like your photo featured on the website?

I understand that the information I have provided will be used by the Kia Ora Hauora programme to provide information and support services to me.
I understand Kia Ora Hauora will follow the Privacy Act 1993 requirements and not use this information for any other purpose, or disclose to a third party without my consent.
I understand I have the right to access and correct information about me that is held by Kia Ora Hauora.
I agree to be contacted by the Kia Ora Hauora programme (via email and SMS messages) about Kia Ora Hauora activities and events.

I agree to the terms and conditions listed above*