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 CourseCore Delegates Training – Stage 1Core Delegates Training – Stage 2Core Delegates Training – Stage 3Core Delegates Training – Stage 4Decent WorkFair Pay AgreementsHealth & Safety – Core TrainingHealth & Safety – Nga Puna Whai orangaOtherIf "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 mailingFull name of staff member who is referring this member:*
