He whare āhuru, he oranga tāngata, he oranga whānau.
Comfortable housing, healthy people, healthy families.
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Screening Questionnaire
All information gathered is completely confidential and your details will not be identified to anyone outside of the MTU
Personal Details
First Name
Last Name
Phone
Email
Select a gender
Male
Female
Mx
Gender
Select an ethnicity
Maori
Pacifica
European
Asian
Other
Ethnicity
Age
Status Details
Select an international status
NZ Citizen
NZ Resident
Visa
International Status
Select a student status
Part Time
Full Time
Not Applicable
Student Status
Select an employment status
Part Time
Full Time
Not Applicable
Employment Status
Housing Details
How many people do you live with?
Select an option
No
Sometimes
Always
Do you have children under 18 living with you?
Select an option
Private landlord
Private landlord with property manager
Palmerston North City Council
Housing NZ
Housing Trust
Other
Who is your landlord?
Other Details
Select an option
Friend/Family
Internet
Used in past
Other
How did you find out about the MTU?
If you found MTU through another agency, which agency was it?
Select an option
Phone
Email
In Person
Facebook
Other
How did you first contact the MTU?
Select all that apply
Difficulty paying rent or bond
Right to quiet enjoyment
Landlord raising rent
Issues with flatmates
Landlord ending tenancy
Accessing social housing
Wanting to end tenancy
Looking for rental home
Poor quality housing
Regaining bond
Lack of repairs or maintenance
Other
What are the main housing issue/s you came to the MTU with?
Any further information you wish to add?
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