Remote Legal Advice Webform Test Page

First Name(s) – Tūingoa Tangata*

Last Name – Ingoa Whānau*

Preferred Name – Ingoa

What name would you like us to call you?

Ethnicity – Mātāwaka*

Other Ethnicity – Mātāwaka Anō

Iwi or Hapū

Gender Expression – Whakaputa Ira*

–

If your sense of personal identity and gender corresponds with your birth sex, you are ‘cisgender’.

Date of Birth – Rā Whānau*

Address – Wāhi Noho*

Phone Number – Nama Waea*

Email Address – Īmēra

Can we email you for feedback? Ka tāea te tuku arotakanga ki a koe?

Y

Income – Whiwhinga Pūtea*

Do any of these apply to you?*

Do you have a disability? He tangata whaikaha koe?*

How did you hear about Community Law? I rāngona e koe mō Te Whare Ture Hapori i hea?

YOUR LEGAL ISSUE

Your Issue – Tō Take*

Please give a brief description of your issue. – Whakamārama mai tō take

What are the names of other people or organisations who are involved with your issue? Ko wai ngā tangata, ngā rōpū ranei e pā ana ki tō take?*

e.g Montgomery ‘Monty’ Burns – employer

What is the best time for us to contact you? If you have any safety concerns, please let us know how we can contact you safely.*

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