Faith Affiliation Questionnaire

Manukau Institute of Technology Chaplaincy Services are collecting this information in order to be better able to provide a range of services for students. All responses are confidential to Chaplaincy Services who guarantee your information will not be passed to others unless you indicate that at question #8. Your honesty in completing the following questionnaire is appreciated.

1. Name: Required only to ensure there are no duplicate submissions
2. Student ID: Required only to ensure there are no duplicate submissions
3. Gender:	Male Female
4. Course: To ascertain which campus you are on
5. Anticipated length of study time at Manukau Institute of Technology:	3 months 6 months 1 year 1 1/2 years 2 years 3 years Other
6. The religious / faith group that I identify with is:	Christian (Catholic, Protestant, Orthodox, other) Jewish (Orthodox, Progressive) Muslim (Suni, Shi'ite, Sufi) Hindu Baha'i Buddhist (Tibetan, Theravada, Zen, other) Rastafarian Taoist Chinese Traditional Japanese Traditional Pagan (Wicca, other) Jain Zoroastrian Sikh None / No religion Other If other please specify
7. I would like to be connected to others of this faith / religious group:	Yes, On Campus Yes, Off Campus No

8. In order for us to connect you, please give your full name and either your email address or a phone contact: (optional)
Name:
Email:
Phone: