First Name
Last Name
Phone number
How well are you looking after your physical health?
1 - Not so Great, 5 - Great
-- Please select an option --
1
2
3
4
5
How well are you looking after your relationships with whanau, partner, friends?
1 - Not so Great, 5 - Great
-- Please select an option --
1
2
3
4
5
How well are you currently managing stress in your work and home life?
1 - Not so Great, 5 - Great
-- Please select an option --
1
2
3
4
5
How positive are you feeling about your apprenticeship?
1 - Not so Great, 5 - Great
-- Please select an option --
1
2
3
4
5
How would you rate your current feelings of confidence, self-esteem or mana?
1 - Not so Great, 5 - Great
-- Please select an option --
1
2
3
4
5
Do you have any concerns about your relationship with alcohol or drugs?
-- Please select an option --
Yes
No
Comments
Feel free to share any additional comments or thoughts about your health and wellbeing in the space below.
Recaptcha
{# Project override of django-recaptcha's v3 script.
The packaged version mints the token once on page load, so a visitor who
spends more than ~2 minutes on the form submits an expired token and fails
validation ("timeout-or-duplicate"). Instead, mint a fresh token at submit
time (per form, keyed by the widget uuid so multiple forms on one page work).
IMPORTANT: this file MUST live in an app's templates dir (here "base", which
is listed before "captcha" in INSTALLED_APPS), NOT in project/templates.
Form widgets are rendered via Django's FORM_RENDERER, whose engine only
searches installed-app template dirs and never the project-level
TEMPLATES["DIRS"]. An override placed in project/templates is silently
ignored. #}