Nominations must be completed and submitted to the Te Pai Ora SSPA national office by 5pm on Thursday 30 October 2025. Please read our National Executive Guidelines before completing this form here.

If you have any questions please contact Ada Tangiora - office@sspa.org.nz

Question Title

* 1. Nominee (please indicate whether you are standing for a tangata whenua or a tauiwi position)

Note: Nominees must be employed or in a governance role within a Te Pai Ora SSPA full-member organisation.

Question Title

* 2. Name of nominee

Question Title

* 3. Job title of nominee

Question Title

* 4. Organisation of nominee (which I confirm is a full and paid-up member of Social Service Providers Aotearoa)

Question Title

* 5. Email of nominee

Question Title

* 6. Phone number of nominee

Question Title

* 7. This nomination is proposed by

Question Title

* 8. Job title of proposer

Question Title

* 9. Organisation of proposer (which I confirm is a full and paid up member of Te Pai Ora SSPA)

Question Title

* 10. Email of proposer

Question Title

* 11. Phone number of proposer

Declaration

Question Title

* 12. Signed by (Proposer type your name)

Question Title

* 13. Proposer please date

Date

Question Title

* 14. Signed by (Nominee type your name)

Question Title

* 15. Nominee please provide date

Date

Question Title

* 16. Nominee - could you please provide a digital head and shoulders photo of yourself. This will be included in the election material sent to voting members.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

Question Title

* 17. Nominees - could you please provide a statement of no more than 250 words about yourself and the contribution you can make to the National Executive. This will be included in the election material sent to voting members.

T