Tertiary Grant First Semester Second Semester Cadetship or Apprenticeship Grant Manaaki Grant Surname:... Date of birth:.../.../...

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1 Tertiary, Vocational & Manaaki Grants Application Form This application is for: (tick one) Year applying for: Tertiary Grant First Semester Second Semester 2018 Cadetship or Apprenticeship Grant 2019 Manaaki Grant 2020 Today s date: Are you a current Ngati Tama registered member: Yes / No Personal Details Surname:... Date of birth:.../.../... First names:... Age: Male / Female Address details: Street Number:... Street Name:... Suburb / Town / City:... Telephone: Home: (0 )... Mobile: (0 )... Postal Address: (if different from above)... (Optional) Facebook name:.. Please name your: Iwi... Marae (Tane) TUPUNA... (Wahine)... (Tane) TUPUNA... (Wahine)... MATUA... WHAEA... KOE Page 1

2 Personal Bank Account Details Your Bank:... Bank Account Name:... Bank Account Number: Please Attach a verified bank deposit/bank receipt or bank statement to your application. (Hand written account numbers on deposit slips must be stamped/verified by your bank) Page 2

3 Tertiary Fill this section in, if you intend on studying at a Polytechnic, College of Education, Whare Wānanga, New Zealand University or private training establishment. Educational achievements to date: (please circle) NCEA Level 1 NCEA Level 2 NCEA Level 3 Scholarship School C Bursary University Entry Others: Intended course of study details: 1. My intended course of study is How many years is this course: Course start date...finish date: Place of study name: Address/ Campus: Is your course a FEES FREE scheme? Yes / No 7. Will you be taking a student loan out from Studylink? Yes / No 8. Have you previously received a tertiary grant from Ngāti Tama Ki Te Waipounamu Trust? Yes / No a) If Yes is this your Second year applying Third year applying Forth year applying b) If Yes Did you pass at least half of your previous years course of study? Yes / No Your career goals and aspirations: (Proof of enrolment or acceptance is required. Please attach a photocopy of your fees invoice or a receipt if you have paid your fees in advance or an acceptance letter) Page 3

4 Vocational Fill this section in, if you intend on partaking in a cadetship or apprenticeship with a company or training provider. Educational achievements to date: (please circle) NCEA Level 1 NCEA Level 2 NCEA Level 3 Scholarship Bursary University Entry Trade Training scheme Gateway/ Star Intended place of cadetship or apprenticeship: Where is your place of cadetship or Apprenticeship taking place: What is the agreed term/ length of time of your cadetship or apprenticeship: Please provide the details of the cadetship/ apprenticeship company or training provider:. Contact Person:.. Is your intended cadetship or apprenticeship a paid position: Yes No Please tell us how you would use a Ngāti Tama grant (up to $500): (Please attach photocopies of quotes, receipts or invoices from any purchases in relation to this cadetship or apprenticeship) Page 4

5 Manaaki Fill this section If you think there are exceptional circumstances that Ngāti Tama Cultural Trust should consider in supporting you with a grant (this may include examples such as whanau events, individual sporting events or significant cultural events). Your achievements to date: Reason for wanting a Manaaki grant:... Please tell us how you would use a Ngāti Tama grant (up to $500): Please provide contact details for any referee s we can contact regarding this grant application: (coach, kaumatua, community leader) (Support letters may also help your application. Please attach photocopies of quotes, receipts or invoices for any purchases in relation to this grant application.) Page 5

6 Check Box & Declaration Attached a verified bank deposit/bank receipt or bank statement to your application Tertiary: Vocational: Attached proof of enrolment or acceptance is required. Please attach a photocopy of your fees invoice or a receipt if you have paid your fees in advance. Details of the cadetship/ apprenticeship company or training provider has been provided. Manaaki: Attached photocopies of quotes, receipts or invoices from any purchases in relation to this cadetship or apprenticeship Support letters may also help your application. Attached photocopies of quotes, receipts or invoices for any purchases in relation to this grant application. Declaration below signed and dated Declaration: 1) I certify that all information supplied in this application is correct. 2) I consent to the tertiary institution in which I am enrolled disclosing information concerning my enrolment and academic records to the Trust executive. Applicant s Signature... Date.../.../... Page 6