Kai Parcel Referral Form

Disclaimer - By filing this form you agree to Massey Matters - Manutewhau Community Hub Koha Kai holding this information for community development purposes. We are only able to open time slots for koha kai pick within hub hours. Please collect as closely to this time as possible. The type of Kai we receive and distribute may vary from week to week. We will try our very best to offer you any of your specified preferences. We have a limited number of koha kai each week, please make sure you reply promptly to any communication to hold your space. If you are missing out consistently due to this restriction please get in touch with us. Our Koha Kai is only in operation on Wednesdays.

If you have expressed a further need in this form you accept Massey Matters/AWHISHED will follow up with you to offer support.

Please note there is a limit to 1 Koha Kai per month. If you consistently require ongoing kai support we may refer you to a financial advisor on site for further assistance and support.

If any questions please email Tua: [email protected]

Name(Required)

First Last

Date of Birth(Required)

Gender

Email(Required)

Phone number

Address(Required)

Street Address Suburb Postal Code

Ethnicity(Required)

Employment Status/Benefit type

How many people in your whanau?(Required)

Please enter a number greater than or equal to 1.

Ages of children?

What has happened for you to require support this week?

Would you like any support with the following:(Required)

Budgeting/financial Services

Employment Services (CV. Interview skills)

Educational/Literacy Services

Mental Health and Wellbeing

Gambling Harm

Addiction Services

Youth Programs/Services

Community Support

How did you find out about us?(Required)

Our Website

Family or Friend

Social Media (facebook, instragram)

Flyer or newsletter

Other

Community Feedback

Please fill in this short questionnaire to help us understand what we can do to help the community

What kind of family events or activities are you most interested in seeing at the community hub?(Required)

Cooking Classes

Arts & Crafts

Sports/Physical Activity

Cultural Events/Workshops

Parenting Workshops

Homework Help/Tutoring

Other

Other(Required)

What day(s) and time(s) would work best for you and your family to attend community events or workshops?(Required)

Weekday mornings

Weekday afternoons

Weekday evenings

Weekend mornings

Weekend evenings

Do you feel there are enough activities available for certain age groups in our community?(Required)

Do you have a specific event or activity idea you would love to see us host in the next 6 months?(Required)

Do you have any skills, talents or hobbies that you would be interested in sharing or running a workshop at the hub (e.g knitting, basic tech support, fitness etc)?(Required)

Would you be happy for us to contact you if any volunteer work become available?(Required)

Yes

Any feedback

Appointment(Required)

Time slot(Required)

Untitled

Please select Category.

Kai Parcel Referral Form

Community Feedback

Massey Hub Contact

Manutewhau Hub contact

Useful Links

site links

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