Nominations must be completed and submitted to the Te Pai Ora SSPA national office by 5pm on Thursday 7 November 2024. Please read our National Executive Guidelines before completing this form here.

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

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* 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.

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* 2. Name of nominee

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* 3. Job title of nominee

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

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* 5. Email of nominee

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* 6. Phone number of nominee

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* 7. This nomination is proposed by

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* 8. Job title of proposer

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

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* 10. Email of proposer

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* 11. Phone number of proposer

Declaration

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* 12. Signed by (Proposer type your name)

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* 13. Proposer please date

Date

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* 14. Signed by (Nominee type your name)

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* 15. Nominee please provide date

Date

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* 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

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* 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.

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