Personal Details

First Name *

Last Name *

Preferred Name *

Date of birth *

Gender *

Primary Ethnicity *

Secondary Ethnicity

Please select the name(s) of your Iwi.

Other Iwi/Villages

Language/s Spoken *

TupuToa embraces all of our community and would like to encourage anyone with an impairment to apply to the programme. Please let us know if there are any impairments or disabilities that may prohibit you from completing tasks expected in the programme.

Special dietary requirements (religious or medical) *

About you

Why do you wish to be a part of the Kia Tupu Kia Toa Leadership Programme?

What are some areas you would like to develop in for your personal and professional growth?

Which cohort do you intend to participate in?

Contact Details

Mobile Number *

Current Address (Suburb and City) *

Email *

Work Phone Number *

Work Address *

Talent Release Form

By participating, you grant us permission to use your name, image, and performance in promotional materials. Your talent will be showcased to a wider TupuToa Movement.

Emergency Contact Details

In the event of an emergency during the programme, please indicate who we are to contact

Emergency Name

Emergency Relationship

Emergency Address

Emergency Phone

Emergency Mobile

Employment/Experience:

Current Employer *

Current role/Job Title *

Sector (Private, Public, Non-Profit, Community etc) *

Length in current role

Employment Support:

Support from your Manager/Organisation:

By providing the following details you are declaring that you have the full support of your employer to participate in the Kia Tupu Kia Toa. Your employer is aware of the time commitment (10 days total, 2 weekend days and some project time) and Programme Fee ($6000 plus GST) which is to be paid prior to the programme commencing, as well as any associated travel and accommodation costs (as appropriate).

Manager Name *

Manager Role *

Manager Phone *

Manager Email *

Personal Commitment:

I have read and understood the programme booklet and information provided. I understand the goals and time commitments of Kia Tupu Kia Toa. I confirm I can attend all five in-person wānanga. I agree to uphold TupuToa values in the way that I engage in the programme and will not engage in any behaviour during the Kia Tupu Kia Toa programme that may damage the reputation of TupuToa. I understand that I am committing myself to lifelong membership of TupuToa Alumni and increased involvement in the TupuToa whanau once I have graduated from the programme *