Request to Join SkillWise
Fields marked with a red arrow must be completed.
This form is written with the intention that the person completing it is the person who wishes to join SkillWise. If you are completing the form on behalf of someone else, please provide their details.
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If you are filling in this form on behalf of someone else, please provide your name and contact details:
First Name
Last Name
SkillWise would like to work with you to live your self-determined good life. Please indicate below if you are looking for work or other activities that will support this
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Would you like any support to catch up with and / or make new friends
Please provide contact details below for the person that wishes to join SkillWise.
Phone number | |
Email address
Date of birth | Sex at birth |
Gender identity | ![]() What is your preferred pronoun? (How should we refer to you?) |
Ethnicity
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Iwi
WINZ number
Which of the following do you have? (Please select one)
Do you have a disability or health condition that will last for at least six months
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Tick all the words that describe your learning disability
Are you on a WINZ benefit? Tick which applies
*You will need to provide a copy of your Work and Income benefit letter as proof of identity*
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I get funding from
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Who is your Life Links Co-ordinator?
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Tick this box if you give us permission to contact your LifeLinks Co-ordinator
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Who is your EGL Connector?
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Tick this box if you give us permission to contact your EGL Connector
Details of key contact person
First Name
Last Name
Their phone number | |
Their email address
Their relationship to you?
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Do you have any plans or assessments you would like to share with us? Please upload these files here if you wish
Please press 'Done' to submit your completed form. You will receive an email response when we have received your information.
If you have Enabling Good Lives (EGL) or Individualised funding, we require more details from you. We will send you an additional form which must be completed before we can accept you into our service.
Thank you