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Online Education Referral Form
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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?
*
Select a Course
Core Delegates Training – Stage 1
Core Delegates Training – Stage 2
Core Delegates Training – Stage 3
Core Delegates Training – Stage 4
Decent Work
Fair Pay Agreements
Health & Safety – Core Training
Health & Safety – Nga Puna Whai oranga
Other
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
No
Does the member have a laptop, computer, smart phone or tablet that they can use for online training?
*
Yes
No
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
No
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:
*