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Nominee form for Pūrākau and Motivational Interviewing workshop

Home > Nominee form for Pūrākau and Motivational Interviewing workshop

Nominee form

You have been nominated by your manager to complete Pūrākau and Motivational Interviewing. 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

Role

How long have you been in your role?

Are you currently working in clinic or the community delivering services to tāngata whai ora?

Yes

Have you completed any other MI 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 the nominee is available to attend both days of this training without interruption.

Confirm availability for both workshop days

Tick this box to confirm the nominee has their own device with reliable internet connection.

Device confirmation

Nominee form for Pūrākau and Motivational Interviewing workshop

Nominee form

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