All applications must be submitted online or received via post by 5pm on 30 September, 2015.

Transcription

1 Application Form Ngārimu VC and 28th (Māori) Battalion Memorial Scholarships 2015/2016 The purpose of the Ngārimu VC & 28th (Māori) Battalion Memorial Scholarship Fund is to provide financial assistance to students of Māori descent who attend a recognised tertiary institution. SECTION ONE SECTION TWO SECTION THREE SECTION FOUR Applicant details Certification of whakapapa To be completed by a person of New Zealand Māori descent Academic endorsement To be completed by a teacher, principal, tutor or lecturer Declaration All applications must be submitted online or received via post by 5pm on 30 September, Applications can be made via post to the following address:- Ngārimu VC and 28th (Māori) Battalion Memorial Scholarships C/- Group Māori Ministry of Education PO Box 1666 Wellington 6140 Please ngarimu.scholarship@education.govt.nz if you have any further questions.

2 Section One - Applicant details Select a Scholarship Which scholarship are you applying for? Undergraduate Masters Doctoral Were you a previous recipient of this scholarship? Yes No If yes, provide details of your previous scholarship. Your personal details Legal name/given name Preferred name State your name as it appears on your birth certificate, marriage certificate, driver s license Surname Gender Male of birth Female Primary home address Suburb DD/MM/YYYY Unit and/or house number and street name City or town Postcode Home phone number Mobile phone number address

3 Do you have any criminal convictions or any criminal charges pending? Yes No If yes, provide details Whanaungatanga Korowai Māori Iwi Hapū Marae Te Reo Rangatira Proficiency in te reo Māori Beginner Conversational Advanced First language Write a brief statement in te reo Māori describing one achievement of the 28th (Māori) Battalion, to show your capability in te reo Māori.

4 Whakapapa Tipuna Paternal grandfather - Koroua ki te taha o tō matua Paternal grandmother - Kuia ki te taha o tō matua Maternal grandfather - Koroua ki te taha o tō whāea Maternal grandmother -Kuia ki te taha o tō whāea Father - Matua Mother - Whāea Applicant - Ko Koe Details of any whakapapa link/s to member/s of the 28th (Māori) Battalion (if known) Your study details Name of tertiary qualification Major(s) (Separate majors with a comma) Name of tertiary provider qualification commenced What year will you complete this course MM/YYYY MM/YYYY

5 Section Two - Certification of whakapapa To be completed by a person of New Zealand Māori descent Certification of whakapapa Full name of applicant I am of New Zealand Māori descent and I am not a silbing, spouse, parent or grandparent of the applicant. Please tick the category that applies to you as the person who can certify this applicant. Kaumātua Māori Tutor/Teacher, Māori Liaison Officer Leader of Māori Community Group (e.g. church or marae), Authorised person of a Māori Authority, Rūnanga or Trust Board Declaration I certify that the applicant named above is of New Zealand Māori descent. Certifier s Name Current position/title Contact phone number Signature

6 Section Three - Academic endorsement To be completed by a teacher, principal, tutor or lecturer Academic endorsement The academic endorsement for this application must be provided by someone who is able to comment on your suitability for study e.g. teacher, principal, tutor or lecturer. I endorse this application because: Endorser s name Current position/title Contact phone number Signature

7 Section Four - Declaration Privacy The personal information on this application form is being collected by the Ministry of Education for the purpose of assessing your eligibility for a Ngārimu VC and 28th (Māori) Battalion Memorial Scholarship, by an assessment panel and the Ngārimu VC and 28th (Māori) Battalion Memorial Scholarship Fund Board. If your application is successful your information will be used for the purpose of awarding the scholarship, including providing profile information about you for the awards ceremony and for media publications about the scholarship, and for the purpose of administering your scholarship. The information collected will not be used or disclosed for any other purpose except in accordance with the Privacy Act You have the right under that Act to access and request correction of any personal information provided. Declaration Full name of applicant I certify that all information supplied is correct to the best of my knowledge, and I acknowledge that my application will be cancelled (without right of review) if the information supplied is incomplete or inaccurate. (If you are under the age of 18 years your parents/legal guardian must complete this section on your behalf) Parent/legal guardian s full name (if under 18 years of age) Parent/legal guardian s signature Applicant s signature