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Faculty of Medical and Health Sciences
Whakapiki Ake Pukatono (registration form)
Fields with (*) are mandatory.
Section One - Eligibility
Are you currently a secondary school student?
*
Yes
No
How long have you been out of secondary school?
*
Have you done any relevant tertiary study/work experience since leaving secondary school?
*
What school do you attend?
*
-- Please Choose --
ACG New Zealand International College
ACG Parnell College
ACG Senior College
ACG Strathallan
ACG Sunderland
Albany Junior High School
Albany Senior High School
Alfriston College
Al-Madinah School
Ambury Park Centre for Riding Therapy
Aorere College
Aotea College
Aquinas College
Arahunga School
Arohanui Special School
Auckland Girls' Grammar School
Auckland Grammar
Auckland International College
Auckland Seventh-Day Adventist H S
Avondale College
Awatapu College
Baradene College
Bay of Islands College
Berkley Normal Middle School
Bethlehem College
Birkenhead College
Bishop Viard College
Blind and Low Vision Education Network N
Blomfield Special School & Resource Ctre
Botany Downs Secondary College
Bream Bay College
Broadwood Area School
Cambridge High School
Cambridge International College
Cambridge Middle School
Campion College
Carey College
Carlson School (Cerebral Palsy)
Carmel College
Central Hawkes Bay College
Central Regional Health School
Chanel College
Chapman College
Chilton St James School
Christian Renewal School
City Impact Church School (Secondary)
Clendon Teen Parent Unit
Coastal Taranaki School
Coromandel Area School
Cullinane College
Dannevirke High School
Dargaville High School
De La Salle College
Destiny School
Dilworth School
Diocesan School For Girls
Drury Christian School
Eden Campus
Edgecumbe College
Edgewater College
Elim Christian College
Epsom Girls' Grammar School
Excellere College
Fairfield College
Fairhaven School (Napier)
Feilding High School
Flaxmere College
Forest View High School
Francis Douglas Memorial College
Freyberg High School
Gisborne Boys' High School
Gisborne Girls' High School
Glendowie College
Glenfield College
Goldfields School (Paeroa)
Green Bay High School
Hamilton Boys' High School
Hamilton Christian School
Hamilton Girls' High School
Hamilton North School
Hamilton's Fraser High School
Hamilton's Fraser High School TPU
Hastings Boys' High School
Hastings Christian School
Hastings Girls' High School
Hato Paora College
Hato Petera College
Hauraki Plains College
Havelock North High School
Hawera High School
Hawke's Bay School for Teenage Parents
He Huarahi Tamariki
He Mataariki School for Teen Parents
Hebron Christian College (Auckland)
Henderson - Teen Parent Unit - He Wero o
Henderson High School
Heretaunga College
Hillcrest High School
Hohepa Home School (Napier)
Horowhenua College
Howick College
Huanui College
Hukarere College
Huntly College
Hutt International Boys' School
Hutt Valley Christian School
Hutt Valley High School
Immanuel Christian School
Inglewood High School
Iona College
James Cook High School
John Paul College
Kaikohe Christian School
Kaipara College
Kaitaia Abundant Life School
Kaitaia College
Kaka Street Special School
Kamo High School
Kapiti College
Karamu High School
Katikati College
Kawerau College
Kawerau Teen Parent Unit
Kea Street Specialist School
Kelston Boys' High School
Kelston Deaf Education Centre
Kelston Girls' College
Kerikeri High School
Kia Aroha College
Kimi Ora School
Kings College
Kingsway School
Kokohuia School
Kowhai School
Kristin School
Kuranui College
Lake Taupo Christian School
Lindisfarne College
Liston College
Living Way Learning Centre
Long Bay College
Longburn Adventist College
Lynfield College
Lytton High School
Macleans College
Mahinawa Specialist School and Resource
Mahurangi College
Makoura College
Mana College
Mana Tamariki
Manaia School (Thames)
Manawatu College
Mangakahia Area School
Mangakino Area School
Mangere College
Manukau Christian School
Manurewa High School
Marcellin College
Marist College
Massey High School
Matamata College
McAuley High School
Melville High School
Mercury Bay Area School
Michael Park School
MindAlive
Mission Heights Junior College
Moerewa School
Morrinsville College
Mt Albert Grammar School
Mt Hobson Middle School
Mt Maunganui College
Mt Richmond School
Mt Roskill Grammar
Naenae College
Napier Boys' High School
Napier Girls' High School
New Plymouth Boys' High School
New Plymouth Girls' High School
Newlands College
Nga Kakano Christian Reo Rua Kura
Nga Purapura o te Aroha
Nga Taiatea Wharekura
Nga Tawa Diocesan School
Ngaruawahia High School
Ngata Memorial College
Northcote College
Northern Health School
Northland College
Northland Health Camp School
Oaklynn Special School
Odyssey House School (Auckland)
Okaihau College
One Tree Hill College
Onehunga High School
Onewhero Area School
Onslow College
Opononi Area School
Opotiki College
Opunake High School
Orewa College
Ormiston Senior College
Otahuhu College
Otaki College
Otaki Health Camp School
Otamatea Christian School
Otamatea High School
Otorohanga College
Otumoetai College
Pa Harakeke Teen Parent Unit
Paeroa College
Pakuranga College
Pakuranga Health Camp School
Palmerston North Boys' High School
Palmerston North Girls' High School
Papakura High School
Papamoa College
Papatoetoe High School
Paraparaumu College
Parkside School
Patea Area School
Patricia Avenue School
Pinehurst School
Piopio College
Pompallier Catholic College
Ponatahi Christian School
Porirua College
Pukekohe Christian School
Pukekohe High School
Putaruru College
Queen Elizabeth College
Queen Margaret College
Raglan Area School
Rangitahi College
Rangitaiki Independent School
Rangitikei College
Rangitoto College
Raphael House Rudolf Steiner Area School
Rathkeale College
Reporoa College
Rodney College
Rongotai College
Rosehill College
Rosehill School
Rosmini College
Rotorua Boys' High School
Rotorua Girls' High School
Rotorua Lakes High School
Rotorua School for Young Parents
Ruapehu College
Ruawai College
Rutherford College
Sacred Heart College (Auckland)
Sacred Heart College (Lower Hutt)
Sacred Heart College (Napier)
Sacred Heart Girls' College (Ham)
Sacred Heart Girls' College (N Plymouth)
Samuel Marsden Collegiate School
Samuel Marsden Collegiate School - Whitb
Sancta Maria College
Scots College
Selwyn College
Sir Edmund Hillary Collegiate Senior Sch
Sir Keith Park School
Solway College
Sommerville School
Sonrise Christian School
Southern Cross Campus
Spotswood College
Springbank School
St Andrew's Middle School (Hamilton)
St Bernard's College
St Catherines College (Kilbirnie)
St Cuthbert's College (Epsom)
St Dominic's College
St Dominic's College (Henderson)
St John's College (Hastings)
St John's College (Hillcrest)
St Joseph's Maori Girls' College
St Kentigern College (Pakuranga)
St Mary's College (Ponsonby)
St Mary's College (Wellington)
St Mary's Diocesan School (Stratford)
St Matthew's Collegiate (Masterton)
St Oran's College
St Patrick's College (Kilbirnie)
St Patrick's College (Silverstream)
St Paul's College (Ponsonby)
St Paul's Collegiate (Hamilton)
St Peter's College (Epsom)
St Peter's College (Palmerston North)
St Peter's School (Cambridge)
Stratford High School
Stratford High School Teen Parent Unit
Sunnydene Special School
Tai Wananga
Taihape Area School
Taikura Rudolf Steiner School
Taipa Area School
Taita College
Takapuna Grammar School
Tamaki College
Tamatea High School
Tangaroa College
Tangaroa College Teen Parent Unit
Taradale High School
Tararua College
Tauhara College
Taumarunui High School
Taupo-nui-a-Tia College
Tauranga Boys' College
Tauranga Girls' College
Tauraroa Area School
Tawa College
Te Aho o Te Kura Pounamu
Te Aroha College
Te Aute College
Te Awamutu College
Te Karaka Area School
Te Kauwhata College
Te KKM o Puau Te Moananui-a-Kiwa
Te Kuiti High School
Te Kura Mana Maori o Whangaparaoa
Te Kura Maori o Nga Tapuwae
Te Kura Maori o Porirua
Te Kura Maori-a-Rohe o Waiohau
Te Kura o Hirangi
Te Kura o Nga Ruahine Rangi
Te Kura Taumata o Panguru
Te Kura Toitu o Te Whaiti-nui-a-Toi
Te Kura-a-iwi o Whakatupuranga Rua Mano
Te Puke High School
Te Rangi Aniwaniwa
Te Waha O Rerekohu Area School
Te Whakatipuranga (Otumoetai TPU)
Te Whanau-A-Apanui Area School
Te Whare Whai Hua Teenage Parent Centre
Te Wharekura o Manurewa
Te Wharekura o Mauao
Te Wharekura o Oparure
Te Wharekura o Rakaumangamanga
Te Wharekura o Ruatoki
Te Wharekura o Te Kaokaoroa o Patetere
Te Wharekura o Te Rau Aroha
Thames High School
The Bridge Academy
The Corelli School
Tikipunga High School
Titirangi Rudolf Steiner High School
Titiro Whakamua
TKK Motuhake o Tawhiuau
TKKM o Hoani Waititi
TKKM o Huiarau
TKKM o Kaikohe
TKKM o Kawakawa mai Tawhiti
TKKM o Mangere
TKKM o Nga Mokopuna
TKKM o Nga Uri A Maui
TKKM o Ngati Kahungunu Ki Heretaunga
TKKM o Ngati Kahungunu o Te Wairoa
TKKM o Ruamata
TKKM o Tamaki Nui A Rua
TKKM o Taumarere
TKKM o Te Ara Hou
TKKM o Te Ara Whanui
TKKM o Te Koutu
TKKM o Te Kura Kokiri
TKKM o Te Raki Paewhenua
TKKM o Te Rawhiti Roa
TKKM o Te Rito
TKKM o Te Tonga o Hokianga
TKKM o Te Waiu o Ngati Porou
TKKM o Tupoho
TKKM o Wairarapa
TKKM o Whakarewa I Te Reo Ki Tuwharetoa
TKKM o Whangaroa
Tokoroa High School
Tolaga Bay Area School
Tongariro School
Totara College of Accelerated Learning
Trident High School
Tuakau College
Turakina Maori Girls' College
Tyndale Park Christian School
Upper Hutt College
Wa Ora Montessori School
Waiheke High School
Waihi College
Waikato Diocesan School For Girls
Wainuiomata High School
Waiopehu College
Wairarapa College
Wairarapa Teen Parent Unit
Wairau Valley School
Wairoa College
Waitakere College
Waitara High School
Waiuku College
Wanganui City College
Wanganui Collegiate School
Wanganui Girls' College
Wanganui High School
Wellington College
Wellington East Girls' College
Wellington Girls' College
Wellington High School & Com Ed Centre
Wentworth College
Wesley College
Westbridge Residential School
Western Heights High School
Western Springs College
Westlake Boys' High School
Westlake Girls' High School
Westmount School
Whakatane High School
Whakatipuria Teen Parent Unit
Whangamata Area School
Whangaparaoa College
Whangarei Boys' High School
Whangarei Girls' High School
Whangaroa College
William Colenso College
Wilson School
Woodford House
Zayed College for Girls
All
ABC
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MNO
PQR
STU
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What school year are you in?
*
Yr 9
Yr 10
Yr 11
Yr 12
Yr 13
Are you interested in pursuing a career in health?
*
Yes
No
Unsure
Are you descended from a Māori (that is, did you have a Māori birth parent, grandparent, great grandparent etc)?
*
Yes (continue to section two)
No (you are not eligible for WAP, please stop here)
Don't know (continue to section two)
Section Two - Student Details
First names:
*
Last Name:
*
Gender:
*
Male
Female
Date of birth:
*
Email:
*
Mobile phone:
*
Home phone:
*
Facebook name:
Postal Address:
*
Suburb:
Town/City:
*
Post Code:
Parent/Legal Guardian Details
First name:
*
Last name:
*
Relationship to you:
*
Mobile phone:
*
Home phone:
*
Email:
*
Address if different from yours:
Section Three - Iwi Affiliation
Which Ethnic Group do you belong to?
Mark the box or boxes which apply to you.
New Zealand European
Māori
Samoan
Cook Island Māori
Tongan
Niuean
Chinese
Indian
Other
Please state:
*
Please complete if you can identify your;
Iwi:
Hapū:
Marae:
Section Four - Recruitment Information
What Health Career/s are you interested In?
Mark all that apply to you.
*
Medicine
Pharmacy
Nursing
Health Sciences
Optometry
Unsure
Other
Please state:
*
What subjects have you taken/currently enrolled in? (Year 11-13 only)
Table A
Yr11
level 1
Yr12
level 2
Yr13
level 3
Table B
Yr11
level 1
Yr12
level 2
Yr13
level 3
Other
Yr11
level 1
Yr12
level 2
Yr13
level 3
Classics Studies
Accounting
Maths
English
Biology
General Science
History
Chemistry
P.E
Geography
Economics
Health
History of Art
Calculus
Te Reo Māori
Statistics
Physics
How did you hear about Whakapiki Ake?
*
Through school
Family/friends
Advertising
Expo
Other
Please state:
*
By submitting this form, I declare that the information is true and correct ▶