Scholarship Application Form

Please complete all fields.

Name*
First Last
Email
Residential Address*
Street Address City ZIP / Postal Code Country
Home Address*
Street Address City ZIP / Postal Code Country
I started my tertiary studies in (year)*
I started my tertiary studies at:*
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From
DD slash MM slash YYYY
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To
DD slash MM slash YYYY
Subjects studied and marks received*
I am studying my second year at the following Tertiary Institution in 2025*
Course description*
What do you intend to do after you have gained this qualification?*
What extra-curricular activities have you been involved in the past three years?*
Have you been involved in any community work in the last three years?*
What do you see as your expenses in 2025 that this scholarship could be used for?*
Name of first referee*
First Last
First referee's phone No.*
Name of second referee*
First Last
Second referee's phone No*
Bank Account Number*

If your application is successfull we will need a bank account number for the funds to be paid into
Age as at the first day of January 2025*
Resident of Mid-Canterbury*
- I, or my parents, reside in the Mid-Canterbury area (please tick)
Declaration*
- I declare that the above information is accurate and correct
Upload CV*
Max. file size: 512 MB.

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