Manawa Gardens - Kaumātua - Ngāti Whakaue Tribal Lands

4. Are you a shareholder in the Incorporation?

Yes No (Go to Q.5)

If Yes, Please enter your Shareholder Number:

5. Are you whānau of a shareholder?

Yes No (Go to Q.6)

Cultural Affiliation

6. What are your Iwi affiliations?

Ngāti Whakaue (Please download and complete the Whakapapa Form) Te Arawa Other No Iwi affiliation (Go to Q.8)

If Te Arawa, please specify:

If Other, please specify:

Cultural Leadership and Participation

We would like to understand your level of current, intended or past commitment to Ngāti Whakaue and our various Marae.

7. Please tell us about your level of Iwi involvement under the following headings

Low (i.e. you attend or support some Iwi commitments) Med (i.e. you have some level of commitment to te reo me ona tikanga) High (i.e. you hold a role of responsibility within the tribe)

Housing Requirements

8. Are you a Ngāti Whakaue kaumātua (65 years or over) and are you interested in applying for one of our “kaumātua units”?

Yes

Please Note: These units (Only 15 are available) are:

Either stand alone or duplex design
1 Bedroom with universal access (wheel chair friendly)
All units have accessible bathrooms with wet areas, (waterproofed), shower tracks and hand rails.

9. What are your housing requirements?

1 bedroom 2 bedroom 3 bedroom 4 bedroom

How many will be living in your home? (Please specify)

How many of those are dependants (under 18 years old)?

10. Does anyone in your household require universal access or disability provisions (i.e. for wheelchairs or mobility scooters) ?

Yes No

Please specify requirements (you may provide medical / or support information).

Medical/ Support Information file:

Accommodation Need

We would like to understand how appropriate these homes are in terms of matching an applicants’ current needs i.e. Does the home’s capacity match a tenants needs?

11. Please tell us whether the houses available match your housing needs in terms of:

Low (i.e. there is a poor house match) Med (i.e. there is a partial house match) High (i.e. there is a perfect house match)

Accommodation Status

12. What is your current accommodation status? Please describe your current situation and/or immediate accommodation needs.

13. Desired length of tenancy:

Short term i.e. less than 1-year Medium term i.e.1-2 years Long term i.e. 3 plus years

Support Systems

We acknowledge that people may need support through whānau or community networks.

14. Please tell us about your current level of support structures/networks that you have in place under the following headings:

Low (i.e. no support systems/networks in place or in use) Med (i.e. some level of support systems/networks in place or in use) High (i.e. strong support systems/networks in place or in use)

Additional Information

Health & Wellbeing

Your Health & Wellbeing status provides us with an understanding of whether the home maybe fit for purpose.

15. Please tell us about your housing modification requirements under the following:

Low (i.e. house requires a high level of modification) Med (i.e. house requires some modification) High (i.e. house requires no modification)

References and Checks

16. Are you able to provide current Tenancy References?

Yes No

17. Do you agree to and give consent for credit/criminal/reference checks?

Yes No

18. Do you have a criminal conviction?

Yes No

19. Are you a member of a gang or affiliated to any gang?

Yes No

20. Is there anything else you would like us to consider?

I have read and understood the Ngāti Whakaue Privacy Policy *.

For Ngāti Whakaue Iwi Affiliations: Please attach a copy of the completed Whakapapa form.

Optional: Please upload any additional documents to support your application.

Manawa Gardens Application form for Kaumātua

Manawa Gardens – Kaumātua

Manawa Gardens Questionnaire Form

Personal Information

Cultural Affiliation

Cultural Leadership and Participation

Housing Requirements

Accommodation Need

Accommodation Status

Length of Tenancy

Support Systems

Health & Wellbeing

References and Checks

Additional Comments

Privacy Policy

Whakapapa Form

Attachments

Ngāti Whakaue Tribal Lands