Online Education Referral Form

This form should only be completed by an E tū staff member.

"*" indicates required fields

What is the member's full name?*

What is the member's membership number (if known)?

What company do they work for?

What course is this referral for?*

If "Other" is selected, please state the course below

What site committee position does the member have?

Delegate

Health & Safety Rep

Leader

Contact

Other

None of the above

If "Other" is selected, please state the position below

Does the member have unlimited internet?*

Yes

Does the member have a laptop, computer, smart phone or tablet that they can use for online training?*

Yes

Ask them to rate your computer skills*

1 – I have no computer skills

2 – I have basic computer skills

3 – I have average computer skills

4 – I have excellent computer skills

5 – I have expert computer skills

Would they like to attend a short online tutorial on how to use zoom?*

Yes

What is the member's email address?*

What is the member's mobile number?

What is the member's full, current home address?

Please provide their FULL address so we can update our records for mailing

Full name of staff member who is referring this member:*

E tū waiata

E tū kahikatea
Hei whakapae ururoa
Awhi mai awhi atu
Tātou tātou e

Stand like the kahikatea tree
To brave the storms
Embrace and receive one another
We are one together

delivering for our members and their families by being competent and capable, agile and reliable
recognised as the most influential leading organisation in NZ and recognized as such globally
relevant to, able to organise, and respected by the ‘worker of the future’
connected, partnered, inclusive and politically influential
growing and well resourced