Nominee form for FACT training for HIPs

Home > Nominee form for FACT training for HIPs

Nominee form

You have been nominated by your manager to complete the FACT training for HIPs. Please complete and submit the form below to complete the application process. Te Pou will confirm allocation of a training space to your nominating manager or lead.

First Name

Last Name

Phone number

Please select your ethnicity from the list below. You can select as many as apply. Use Control-Click to select more than one option.

Ethnicity

Professional body

Professional registration number

Professional qualifications

Qualification titles

Are you currently working in clinic delivering HIP services to tāngata whai ora?

Yes

How long have you been in your role?

Have you completed any other FACT training in the last 12 months?

Yes

If yes please provide details

Why are you interested in this training?

Why are you interested in this training and how do you envisage applying this in your current or future roles?

Please provide any other information that might be useful for us to know.

Tick this box to confirm you are available to attend the full day of training without interruption.

Confirm availability full workshop day

Tick this box to confirm you have your own device with reliable internet connection.

Device confirmation

Nominee form for FACT training for HIPs

Nominee form

Resources

Our work