Waipawa Building
Society Scholarship
Application Form 2020
Central Hawke’s bay District Council
Waipawa Building Society Scholarship Application Form 2020
Together we Thrive! E ora ngātahi ana!
1
WAIPAWA BUILDING SOCIETY SCHOLARSHIP TRUST
If you have any questions about this application form, please contact the Governance & Support
Officer, Bridget Gibson at the Central Hawkes Bay District Council, Telephone: 06 857 8060 or email:
governance@chbdc.govt.nz
Once you have completed the form, please return it (with attachments) by 4.30pm, Friday, 6
November 2020
to:
Bridget Gibson
Waipawa Building Society Scholarship Trust
Central Hawkes Bay District Council
P O Box 127
WAIPAWA 4240
Or mail to governance@chbdc.govt.nz
Please Note:
Criteria the Trustees will use when considering your application:
1 You must live in Central Hawkes Bay.
2 You must be intending to attend, or actually attending a course of tertiary education in New
Zealand.
3 They will consider how much you will suffer financial hardship by attending the course.
4 You should be capable of improving your future educational prospects by attendance at the
course.
5 Preference will be given to people who have not received funds from the Trust before, except
in cases of extreme financial hardship.
6 That excepting special circumstances, preference will be given to applicants who will be
attending their first year of tertiary education.
7 It is important that all sections of the application form are completed.
Page 1
WAIPAWA BUILDING SOCIETY SCHOLARSHIP TRUST
APPLICATION FORM
NAME:
ADDRESS: (Home)
(Postal - if different from above)
HOME PHONE: __ __________________ MOBILE: __________________________
AGE NEXT BIRTHDAY: _______________
EMAIL ADDRESS:_______________________________
PROPOSED TERTIARY COURSE:
Please advise which Tertiary Course you will be taking and the Institution you will be attending next year.
EDUCATION:
PRIMARY SCHOOL(S) ATTENDED:
SECONDARY SCHOOL(S) ATTENDED:
CURRENT YEAR LEVEL/OCCUPATION: ___________________________________
PERSONAL DETAILS:
Central Hawke’s bay District Council
Waipawa Building Society Scholarship Application Form 2020
Page 2
EDUCATION: (continued)
NCEA -
LEVEL 1 (Please circle totals where Endorsements have been gained)
Subject
No. of Achieved
Credits
No. of Merit Credits
No. of Excellence
Credits
Total Credits Gained
OVERALL TOTAL
CREDITS
LEVEL 2 (Please circle totals where Endorsements have been gained)
Subject
No. of Achieved
Credits
No. of Merit Credits
No. of Excellence
Credits
Total Credits Gained
OVERALL TOTAL
CREDITS
Central Hawke’s bay District Council
Waipawa Building Society Scholarship Application Form 2020
Page 3
LEVEL 3 (Please circle totals where Endorsements have been gained)
Subject
No. of Achieved
Credits
No. of Merit Credits
No. of Excellence
Credits
Total Credits Gained
OVERALL TOTAL
CREDITS
Please attach RECORD OF LEARNING/NCEA RESULTS SUMMARY from NZQA to reflect the information provided above.
OTHER EDUCATIONAL QUALIFICATIONS:
List any other qualifications eg, Bursary, Scholarship etc.
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
_______________________________________ _____________________________________
ACADEMIC, CULTURAL AND SPORT ACHIEVEMENTS:
List below any other academic, cultural, sport, or outside school achievements.
Central Hawke’s bay District Council
Waipawa Building Society Scholarship Application Form 2020
Page 4
WORK EXPERIENCE:
AIMS AND GOALS:
Please write in your own words what your aims and goals are once you have completed your Tertiary education. (Continue
on a separate sheet if necessary)
GENERAL:
Are there any other circumstances which you wish the Trustees to take into account when they consider your application?
Central Hawke’s bay District Council
Waipawa Building Society Scholarship Application Form 2020
Page 5
BUDGET OF INCOME AND EXPENDITURE:
Please estimate your approximate income and expenditure for your next year of study, including your
course and living expenses etc. Please do not include a student loan in your income
.
PROJECTED INCOME EXPENDITURE
SAVINGS ACCUMULATED
Total: Total:
Pleas
e state whether you are eligible for a Student Allowance:
YES NO
If you have answered ‘Yes’, please state amount
$ _____________________
Please state any other scholarships, grants, or allowances you are eligible for. Please state amount
________________________________________________________ $ _____________________
________________________________________________________ $ _____________________
________________________________________________________ $ _____________________
Have you received the Waipawa Building Society Scholarship previously? : YES NO
I declare that the information supplied here is correct to the best of my knowledge.
Signed:
Date:
Return by 4.30pm on Friday, 6 November 2020 to:
Bridget Gibson
Waipawa Building Society Scholarship Trust
C/- Central Hawkes Bay District Council
P O Box 127
WAIPAWA 4240
Or by email:
governance@chbdc.govt.nz