Health Coaching for Wellbeing

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Trainee Details

Training Start Date *

First Name *

Last Name *

Email Address *

Mobile Number *

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Employment & Organisation Details

Employer / PHO / Organisation Name *

Work Email *

Employment start date *

What FTE and what days will the HC be working *

Physical Work Location (Clinic) *

Manager / Team Lead Name *

Manager / Team Lead Email *

Manager /Team Lead Phone Number *

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Person to contact in regards to this enrolment if different from above:

Name
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Phone Number
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Email
(Optional)

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Professional Background

Relevant Qualifications (if any) *

Relevant Experience (e.g. health, wellbeing, mental health, community work) *

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Declaration & Consent

Declaration *

I understand that enrolment does not guarantee certification and is subject to programme requirements being completed I consent to Tāmaki Health collecting and storing this information for training and reporting purposes, in line with privacy obligations I confirm this trainee has not previously completed IPMHA Health Coach Training with any provider I confirm that the information provided in this form is accurate, complete and current to the best of my knowledge