Poripori Farm A Trust Application for Tertiary Education Grant for 2015

Poripori Farm A Trust
Application for Tertiary Education Grant for 2015
Notes to the Applicant:
All sections must be fully completed.
(a)
The Poripori Farm A Trust Tertiary Education Assistance Grant is available from your 2nd
year of study onwards.
(b)
Two (2) Scholarships will be awarded to Post Graduate Applicants, and Grants awarded to
Tertiary Applicants.
(c)
The Application Form is to be completed and must reach Poripori Farm A Trust, c/- Te
Awanui Huka Pak Ltd, PO Box 4626, Mt Maunganui South 3149, no later than 31 March
2015.
(d)
The applicant must be an owner or descendant of an owner in Poripori Farm Trust.
(e)
The applicant must be studying full time at a New Zealand Tertiary Institution.
(f)
The application must be accompanied by proof of enrolment from your New Zealand
Tertiary Institution for the current year.
(g)
The application must provide previous academic results.
(h)
The applicant must submit a covering letter and a CV providing additional information to
assist in the selection process.
(i)
The Selection Panel’s decision is final and any late or incomplete applications will not be
considered.
Check Box:
Second year of Study
Owner or descendant of owner
Studying Full Time
Proof of enrolment
Previous Academic Results
Covering Letter
CV
Additional information that may assist
Signed off by shareholder
Poripori Farm A Trust Education Grant Application
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Section A:
Full Name of Applicant:
Surname:
___________________
First Names: __________
Postal Address:
________________________________________________________
________________________________________________________
Phone No:
(
) ___________________ or ___________________
Email Address:
________________________________________________________
Date of Birth:
________________
Are you an owner in the Poripori Farm A Trust?:
Yes ______ No ______
Shareholder Number (if known): ____________________
_____________________________________________________________________
Section B:
1.
What Tertiary Institute are you attending: ………………………………………………………………………..
2.
What Degree/Diploma Course are you pursuing: ………………………………………………………………
3.
State the year of study (i.e. 2nd, 3rd etc.): ……………………………………………...
4.
Full Time Study:
5.
What subjects are you taking this year? (separate into semesters if applicable):
Yes / No
1st Semester
Poripori Farm A Trust Tertiary Education Grant Application
2nd Semester
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6.
What are your career goals?
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
7.
Please state any other financial assistance that you are receiving:
…………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………
8.
Bank Account No: ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ ___ ___ ___ - ___ ___ ___
(Please attach a bank deposit slip).
Section C:
WHAKAPAPA
Fill in your Whakapapa to show clearly that you are a beneficiary of the Poripori Farm A Trust.
Only one branch of Whakapapa (either fathers or mothers side) is required. Verification will be
made by the Selection committee.
PLEASE PRINT FULL NAMES:
GREAT/GREAT-GRAND PARENT: …...……………………………………………………………………………………………
GREAT-GRAND PARENT: …..………………………………………………………………………….……………………………..
GRANDPARENT: …………..…………………………………………………………………………….……………………………….
PARENT (father/mother): .………………………………………………………………………..…………………………………
Applicants’ Declaration:
I ___________________________________ (full name) declare that the information that I have
provided is true and correct.
Signed: _____________________________
Date: ________________________
Shareholders Declaration:
Shareholder name:
______________________________________
__
Signed: _____________________________
Date: ________________________
Relationship to Applicant: ____________________________
______________________________________________________________________
Please forward your application to:
Poripori Farm A Trust, c/- Te Awanui Huka Pak Ltd, PO Box 4626, Mt Maunganui South 3149
no later than the 31st March 2015 as in accordance with the Education Grant Policy.
Poripori Farm A Trust Tertiary Education Grant Application
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