Chapel Bursary application for entry in 2017

Transcription

1 Chapel Bursary application for entry in 2017 BURSARY The Chapel bursary is available for new students in years 9 to 13 who are actively involved in the Anglican Church. This bursary offers up to 50% off tuition fees for the duration of study at Diocesan. Applicants will be expected to demonstrate their commitment to the Anglican expression of our School through their leadership of or involvement in a student led faith development/exploration group and at least one of the following: Chapel reading, Chapel serving, contributing to music in the Chapel or belonging to a choir. WE WISH TO APPLY FOR A CHAPEL BURSARY FOR MY/OUR DAUGHTER Student Name: Year Level: Year: 2017 Financial circumstances mean that an independent school education would not be possible without this assistance. We understand that we are asked to make a statutory declaration of family financial income and assets, including benefit from trusts. Continuation of this bursary is subject to continuing to meet the Chapel bursary criteria, good academic performance, exemplary behaviour, and participation in the overall life of the School. The Chapel bursary is only available to New Zealand citizens and permanent residents only. Your application needs to be accompanied by a Diocesan School for Girls application form. Inside the application form, please write Chapel Bursary Applicant and enclose it with the completed bursary form and supporting data. There is a 100 non refundable registration fee for Chapel bursaries to be paid when you submit your application. This replaces the standard 250 school application fee. If you pay via internet banking please use your daughter s name and the words chapel bursary as a reference. The School s bank account details are Please include copies of additional information such as recent school reports, results and certificates. Do not send original documents or awards. Should the student be successful in attaining a bursary, the student s family is responsible for the registration fee, enrolment fee, the remainder of the tuition fees, as well as all incidental costs including, but not limited to, laptop, school trips, uniforms and stationery. Chapel Bursary Application Form for Entry in 2017 Page 1 of 10

2 Student Information PERSONAL Student Name Date of birth Phone Number Address ACADEMIC RECORD Name of School Attach photo here Years attended ACADEMIC ACHIEVEMENT Your current teacher will be able to complete this section. If you are a senior student, please attach a copy of all your academic results e.g. NCEA National Standards (Literacy and Numeracy) Level Date Reported Reading Writing Number and Algebra Geometry and Measurement Statistics and Probability OVERALL Tests Level/Stage Raw Score Stanine Date of Testing PAT Reading Comprehension PAT Listening PAT Reading Vocabulary PAT Mathematics asttle or e-asttle asttle or e-asttle asttle or e-asttle Mathematics Mathematics Writing Reading Numeracy GloSS IKAN Numeracy (any other info) ICAS ICAS ICAS English Mathematics Other Chapel Bursary Application Form for Entry in 2017 Page 2 of 10

3 ADDITIONAL INFORMATION Please include information relating to the past two years only. Please include copies of certificates or supporting information demonstrating excellence. Community Involvement: Qualifications and experience in the Arts: Qualifications and experience in Sports: Any other awards or achievements: Chapel Bursary Application Form for Entry in 2017 Page 3 of 10

4 Statement of Financial Position Note: All information collected is treated in the strictest of confidence. FAMILY INCOME (in New Zealand Dollars) Employment 1. Please indicate for each primary caregiver whether they are employed, self employed or unemployed: 1a. First primary caregiver: Employed Self Employed Unemployed 1b. If you circled Self employed, please provide details of the business in the box provided and attach your last financial year statements. 2a. Second primary caregiver: Employed Self Employed Unemployed 2b. If you circled Self employed, please provide details of the business in the box provided and attach your last financial year statements. 3a. Third primary caregiver: Employed Self Employed Unemployed 3b. If you circled Self employed, please provide details of the business in the box provided and attach your last financial year statements. Last financial year income Please declare the total gross income earned in the last financial year (1 April 31 March) for each primary caregiver. This does not include Working For Families tax credits. 4. First primary caregiver: 5. Second primary caregiver (if applicable): 6. Third primary caregiver (if applicable): TOTAL: If requested, applicants should be able to furnish evidence to corroborate the information provided. Chapel Bursary Application Form for Entry in 2017 Page 4 of 10

5 FAMILY INCOME Continued Reduced or increased household income since 31 March 7. Has your total household income reduced, increased, or stayed approximately the same since the end of the last financial year (31 March)? 8. If you ticked stayed the same, please move to question 9. 8b. If you ticked reduced, please explain why, in the box to the right. 8c. If you ticked increased, please explain why, in the box to the right. 8d. Please indicate what your reduced or increased total household income is now and provide verification of this. 8e. If you ticked reduced in question 7, do you anticipate that your household income will return to its original level in the coming year? For example, if you have just left your current employment, do you intend on working at the same level in the next year? Reduced Increased Stayed the same 8f. If you answered question 8e, please explain why. Otherwise, go to question 9. Yes No Additional Income 9. Does anyone other than the student s primary caregivers provide financial assistance for this student? Yes No 9a. If yes, please indicate who by ticking all that apply. If no, go to question 10. Father Mother Grandparents Other family/whanau Other (please state) 10. Please explain: 10a. The type(s) of financial assistance that is provided, for example, compulsory child support or voluntary payments etc 10b. How much financial assistance the stated person/people provide per week. 11. Was any other additional income received by the student s primary caregiver(s) during the last financial year other than that already mentioned, above? Yes No 11a. If yes, please list each source of income, and the total amount received during the last financial year. Source(s) of Income: Total income amount(s) Chapel Bursary Application Form for Entry in 2017 Page 5 of 10

6 FAMILY NET WORTH (In New Zealand Dollars) 12. Do you own any property? Please note that if you share ownership of a property, the full value of the property must still be declared (in question 14) unless you have legal verification that shows proportionate ownership. 12a. If no, please move to question 13. If yes, please indicate how many properties you own in the box to the right. 12b. Please explain what each property is used for. 13. Do you rent the property you live in? 14. Please add the dollar value of all specified assets and debt that you have, in the table below. Please fill in every box and write 0 (zero) if the value is 0 (nothing). Assets Value Liabilities Value 14a. Cash (including term deposits and funds held in savings accounts) Yes Yes 14f. Total amount owing on any mortgage(s) No No 14b. Total value of all property owned as verified by a Quotable Value (QV) rating or a Council Rating Value (RV) 14c. Total market value of any business interests 14d. Total resale value of vehicles, boats and/or other recreational vehicles 14e. Total value of investments 14g. Total amount owing on cars, boats, and/or any recreational vehicles 14h. Total amount owing on student loans 14i. Amount owing on credit card(s) 14j. Amount owing on store card(s) TOTAL ASSETS TOTAL LIABILITIES TRUSTS If the student and/or their caregivers are beneficiaries of any trusts, this may affect eligibility for Bursaries. However, this criterion can be waived if the applicant makes an acceptable case for doing so. For example, if a student is a beneficiary of a trust but will never receive more than 100 for school books per year from the trust, the criterion can be waived. But, for example, if the student and/or caregiver is a beneficiary of a family trust, and there is a property in the trust with a current net worth value exceeding the 200,000 net worth eligibility threshold, the criterion would not be waived. 15. Is the student and/or any of the student s primary caregivers beneficiaries of any trusts? Yes No If no, please move to Statutory Declaration. If yes, please describe (below): 15a. How many trusts 15b. What type of trust(s) these are 15c. The total value of any assets in the trust(s) 15d. The total income received from the trust during the last financial year. Chapel Bursary Application Form for Entry in 2017 Page 6 of 10

7 STATUTORY DECLARATION (to be handwritten) I/we, of, solemnly and sincerely declare that the information I have provided in this application is true and correct. We agree that if a Chapel bursary is awarded we will complete the formal offer contract. I/we make this declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act Signature(s): Declared at: Date: Official witness name, in full: full name of primary caregiver(s) home address(es) town/city/district Signature of witness: Occupation of witness: Address of witness: This statutory declaration must be witnessed by a solicitor, a Justice of the Peace, a Court Registrar, or other person authorised to take a statutory declaration. There are penalties under the Crimes Act for providing false information and provision of false information will also result in the termination of the Bursary. PRIVACY STATEMENT The personal information in this application is being collected by Diocesan School for Girls for the purpose of considering your application for a Chapel bursary. The information will be used only for the purpose of considering the application, administering the bursary if the application is successful, and for statistical and research purposes. The identities of all applicants will remain protected by the Principal and the School, and will not be released to the general public. The information collected is held by the School and you have the right to access and request correction of this information. Chapel Bursary Application Form for Entry in 2017 Page 7 of 10

8 TIMELINE FOR CHAPEL BURSARY Applications for Chapel bursary open on Monday 15 February and close on Thursday 7 April 2016 at midday. No late applications will be accepted. All applicants are required to sit our examination at Diocesan School for Girls on Thursday, 5 May 2016 starting at 8.50am and finishing at 11am. Please bring a water bottle and morning tea. Following the examination, applicants will be shortlisted and invited to attend an interview on Tuesday, 31 May All applicants will be notified of the outcome of their application in writing by 30 June CHECKLIST Chapel bursary application Diocesan School application form 100 registration fee - the School s bank account details are Copy of New Zealand birth certificate or New Zealand passport Copy of the student s end of year 2015 school report If you are a senior student, please send copies of your academic achievements e.g. NCEA Copies of supporting documents - reports, certificates and achievements Copy of any Educational Assessments, for example, an Educational Psychologist report A recent passport size photograph Please ensure that you have provided the Confidential Parish Reference form to your Vicar/ Minister to complete and return to the school. THE COMPLETED CHAPEL BURSARY APPLICATION FORM SHOULD BE SUBMITTED TO The Admissions Director Diocesan School for Girls Private Bag Newmarket Auckland 1149 Chapel Bursary Application Form for Entry in 2017 Page 8 of 10

9 CONFIDENTIAL PARISH REFERENCE FOR CHAPEL BURSARY Please have your Vicar/Minister complete the following two pages and return them to the school. Name of Applicant: Name of Vicar/Minister in Charge: Parish: Address of Parish: How long has the applicant/family been involved in your Parish? Please describe any history of involvement in another parish if applicable: Please comment specifically on the following: (a) Active involvement of applicant in your parish: (b) Active involvement of applicant s family in your parish: (c) Baptism/confirmation details of applicant: Chapel Bursary Application Form for Entry in 2017 Page 9 of 10

10 (d) Benefits of education at Diocesan School for this applicant: (e) LIkely contribution of this applicant to Diocesan School: SIGNED Signature of Referee Date PLEASE RETURN THE COMPLETED REFERENCE DIRECTLY TO: The Admissions Director Diocesan School for Girls Private Bag Newmarket Auckland 1149 Chapel Bursary Application Form for Entry in 2017 Page 10 of 10