Scholarship Application "*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.Family Name:*First Name(s):*Title:* Mr Ms Mrs Miss Other Postal Address:* Street Address Address Line 2 City ZIP / Postal Code Email:* Mobile Phone:*Date of Birth:* DD slash MM slash YYYY Age of Applicant:*A passport size, colour photograph of yourself, i.e your student ID photo.*Accepted file types: png, jpg, gif, pdf, Max. file size: 100 MB. Attach any qualifications, including any relevant transcripts or documentation of courses, level pass rates etc:Max. file size: 100 MB. Shareholder or Whānau Trust DetailsShareholder's Name or Whānau Trust Name:*If the Shareholder is a Whānau Trust please provide name of the donor of the shares & Responsible Trustee:Shareholder Number (if known):About Your CourseAre you completing a Trade? Yes No You are also required to provide us with a completed Trade Scholarship form from the link below* Trade Scholarship Form *This form must be completed by your tutor or employer. You may share the link with them or print a copy.Institution at which you will be enrolled:*Qualification to be completed during the Scholarship:*Date of enrolment:* DD slash MM slash YYYY Expected date of completion of your qualification:* DD slash MM slash YYYY Bank Details (certified correct by bank):*Max. file size: 100 MB. Schedule and/or invoice of the cost of your study for the year:*Max. file size: 100 MB. Are you receiving/applying for other Scholarships/Grants/Bursaries?* Yes No Other Scholarships/Grants/Bursaries*If receiving or applying for multiple other scholarships, grants or bursaries, click on the plus symbol to add another row to add the details. Amount:From: Add RemoveTotal from other Scholarships/Grants/Bursaries:*Please write a reflection of your learning / experiences at high school and other studies to date which have influenced your choice of study:*Referee 1 Name:*Referee 1 Contact details:*Referee 2 Name:*Referee 2 Contact details:*Additional NotesAcknowledgement* I hereby certify that the information set out in this application form is correct Signature of applicant:*Date* DD slash MM slash YYYY Proof of WhakapapaWe only require you to complete the side of the family who whakapapa to the shareholder and we only require the names from the student to the shareholder. For example, if the shareholder is the student’s grandmother on the mother’s side, you would only be required to enter the student’s name, mothers name and grandmother’s name.Student's Name*Mother's Side Family TreeMother's Name:Grandmother's Name:Grandfather's Name:Great Grandmother's Name:Great Grandfather's Name:Great Grandmother's Name:Great Grandfather's Name:Father's Side Family TreeFather's Name:Grandmother's Name:Grandfather's Name:Great Grandmother's Name:Great Grandfather's Name:Great Grandmother's Name:Great Grandfather's Name:If you have not previously received a grant from Aotearoa Trust, please attach certified birth certificates to support whakapapa (only required to attach certified birth certificates for those we do not hold a copy for) Drop files here or Select files Max. file size: 100 MB. This field is hidden when viewing the formFor Admin Use OnlyThis field is hidden when viewing the formGrant History
