Kai Parcel Referral Form

Disclaimer

By submitting this form, you agree to Massey Matters – Mānutewhau Community Hub Koha Kai collecting and holding this information for community development purposes.

Koha Kai is only available on Wednesdays and must be collected during Hub opening hours at 74b Oreil Avenue, West Harbour. Please collect your kai as close to your allocated time as possible.

The type and quantity of kai we receive and distribute may vary from week to week. We will do our very best to offer any preferences you specify; however, this cannot be guaranteed.

We have a limited number of Koha Kai available each week. Please respond promptly to any communication to secure your space. If you are missing out consistently due to this limitation, please contact us.

If you indicate further needs in this form, you acknowledge that Massey Matters / AWHISHED may follow up with you to offer additional support.

Please note there is a limit of one (1) Koha Kai per month. If you require ongoing kai support, we may refer you to an on-site financial advisor for further assistance.

If you have any questions, please email Tua at: [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)

Kai Parcel Referral Form

Community Feedback

Massey Hub Contact

Manutewhau Hub contact

Useful Links

site links

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