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2015 TERTIARY EDUCATION GRANT APPLICATION FORM CLOSING DATE: Tuesday 31 March 2015 at 4.00pm PLEASE SEND APPLICATIONS TO: Postal Address: PO Box 227 Whakatane Contact Info: Telephone (07) 929 5690 Email: grants@omataroa.com Physical Address: Omataroa Rangitaiki No 2 Trust Te Wairere House 6 Wairere Street Whakatane OFFICE USE ONLY: Date Received: / / Applicants First Name: Last Name Email: Enrolment Verified: Yes No Tax Invoice Received: Yes No Whakapapa Verified: Yes No Name of Current Shareholder Correct: Yes No Shareholder Registration No: Identified: Yes No Bank Account Verified: Yes No Yes No Total Fees: $ Current Shareholder Name: Registration Completed: Comment: TERTIARY GRANT POLICY 1 EDUCATIONAL ASSISTANCE 1.1 Grants are available to Owners or a Natural Issue of an Owner who are studying at a recognized tertiary education institution. 1.2 Grants and scholarships are available for fulltime and part-time study. 2 AWARDING OF GRANTS In determining educational awards, Trustees will also consider the following circumstances: 2.1 The amount of total fees levied by the Tertiary Institution. 2.2 A brief written statement covering the following: a) Commitments by members of your Whanau to assist you in your academic studies b) Your own contributions, past, present or future towards the general well-being of your Whanau, Hapu and Iwi c) Any other special circumstances 3 APPROVAL OF GRANTS 3.1 All applications will be referred to the Grants Sub-Committee for assessment. 3.2 Grants approved will be paid in two equal instalments as follows: a) Instalment 1 upon approval of grant b) Instalment 2 upon production of certified results from the Tertiary Institution for the current study period c) Second Instalment will be due for payment by the end of March 2016 4 ADDITIONAL INFORMATION 4.1 The tenure of the grant shall be for one year only. Applicants must submit a new application each year. 4.2 Closing date for applications will be Tuesday 31 March 2015 at 4.00pm. 4.3 Incomplete and late applications will not be considered. 4.4 Grants will contribute towards tuition fees only. 4.5 If an applicant withdraws from their course or individual papers prior to receiving funding, or after receiving funding they must notify the Trust. If this does not occur, an applicant may not be eligible for further grants. 4.6 The Trust reserves the right to use a successful applicants name and other details for publicity and promotion purposes. 4.7 The Trustees have the sole discretion to accept or decline any application that does not meet grant criteria. 2 SECTION 1: APPLICANT DETAILS First Name: Middle Name: Surname: Gender: Male Date of Birth: Female / / Age: SECTION 2: APPLICANT POSTAL DETAILS Postal Address: Post Code: Phone (Day): ( ) Cell phone No: ( ) Email Address: SECTION 3: APPLICANT BANK ACCOUNT DETAILS BANK ACCOUNT BANK ACCOUNT NAME: (Applicant Account) BANK ACCOUNT NUMBER: Once you have completed the above details please attach a Bank generated deposit slip. Bank Verified Stamp 3 SECTION 4: EDUCATION DETAILS Tertiary Institution: Address: Telephone: ( ) Fax Number: ( ) Email Address SECTION 5: COURSE DETAILS Course of Study: Course Duration: Start Date:_______________ End Date:_________________ Level of Qualification (Please tick relevant box) Bachelor Degree Certificate Conjoint Degree Diploma Masters P.H.D Post Graduate Degree Other: (Please State) 2015 Year of Study (Please tick relevant box) 1 year 2015 Type of Study (Please tick relevant box) Full Time 2 year 3 year 4 year 5 year 6 year Part Time CHECKLIST Confirmation of Enrolment Please attach: Letter of acceptance, dated this year, from Institute stating study being undertaken and period of enrolment Student Fees Please attach: A copy of the STUDENTS INVOICE, dated this year, verifying the fees charged relating to the students 2015 enrolment as confirmed above. 4 SECTION 6: WHAKAPAPA DETAILS Please show clearly that you are a current shareholder OR a descendant of a current shareholder of Omataroa Rangitaiki No 2 Trust SECTION 6.1: SHAREHOLDER DETAILS If this information is inaccurate or incomplete your application will be declined 1. Applicant must be a current shareholder or a direct descendant of a current shareholder 2. The name of the Shareholder must correspond with the name of a Current Owner in Trust. (Please refer to the Maori Land Court Website @ www.maorilandonline) 3. Current Shareholder must register their contact details with the Trust by completing a Registration Form. (OMR2 Shareholder Registration Forms are available from the Office) 4. Please ensure that you have correctly entered the Shareholders Registration No: Do not leave this blank or use an incorrect number as your application may be considered incomplete: We advise students to contact the office if shareholder number is unknown. Current Shareholder Name: (Individual) (if applicable) Current Shareholder Name: (Whanau Trust) (if applicable) Shareholder Registration No: (Contact the office if unknown) SECTION 6.2: WHAT IS YOUR RELATIONSHIP TO THE SHAREHOLDER (TICK ONE) I am the Shareholder OR The Shareholder is my My Parent My Grandparent My Great Grandparent The Shareholder is a Whanau Trust 5 SECTION 6.3: WHAKAPAPA DETAILS Provide the side of the whakapapa which includes the shareholder TUPUNA OF WHANAU TRUST (IF APPLICABLE) GREAT GRANDPARENT: GRANDPARENT: PARENT: APPLICANT: KAUMATUA VERIFICATION: I ..............................................................................(name) do hereby confirm that the above Whakapapa details are true and correct. Signed: ---------------------------------------------------------- WHANAU TRUST: TRUSTEE VERIFICATION If the current shareholder is a Whanau Trust, a trustee must also confirm both the identity of the student and their Whakapapa to the Whanau Trust. I ..............................................................................(name) am a Trustee of the Whanau Trust do hereby confirm the applicant is a beneficiary of the Trust. Signed: ---------------------------------------------------------- CHECKLIST Whakapapa Verification This must be signed by a Kaumatua who can confirm both the identity of the student and whakapapa to a current shareholder in Omataroa Rangitaiki No 2 Trust. If the student is an owner, this section must still be signed as it is to verify the students’ identity Shareholder Registration No Please ensure your have correctly entered the Shareholders Registration Number on Page 5 of this application. Do not leave this blank or use an incorrect number as your application may be considered incomplete: We advise students to contact the office if shareholder number is unknown. Whanau Trusts: Trustee Verification A trustee must also confirm both the identity of the student and their whakapapa to the Whanau Trust. 6 SECTION 7: PERSONAL STATEMENT 7.1 Commitment by members of your Whanau to assist you in your academic studies: 7.2 Your own contributions, past, present or future towards the general well-being of your Whanau, Hapu and Iwi: 7.3 Any other special circumstances 7 SECTION 8: DECLARATION I hereby certify that the information in this application form is correct, and that my application may be cancelled (without right of review) if the information supplied is incomplete, inaccurate or not supplied by due date. I consent to any of this information being made available to Omataroa Rangitaiki No 2 Trust for statistical purposes, and for my name to be used as a Successful Grant Recipient for publicity and promotion purposes. I consent to the Tertiary Institution with which I am enrolled releasing any information required concerning my application form to Omataroa Rangitaiki No 2 Trust in accordance with the Privacy Act 1993 and the Education Act 1989. I consent to Omataroa Rangitaiki No 2 Trust contacting any Agencies to verify that information provided in this application is true and correct, in accordance with the Privacy Act 1993. Signature Date 8 CHECKLIST Please remember to complete & attach the following documentation Bank Account Verification The student’s bank account must be verified by a bank generated deposit slip. Confirmation of Enrolment Please attach: Letter of acceptance, dated this year, from Institute stating study being undertaken and period of enrolment Student Fees Please attach: A copy of the STUDENTS INVOICE, dated this year, verifying the fees charged relating to the students 2015 enrolment as confirmed above. Personal Statement Student must complete their Personal Statement Whakapapa Verification This must be signed by a Kaumatua who can confirm both the identity of the student and whakapapa to a current owner in Omataroa Rangitaiki No 2 Trust. If the student is an owner, this section must still be signed as it is to verify the students’ identity. Whanau Trusts: Trustee Verification If the current shareholder is a whanau trust, a trustee must also confirm both the identity of the student and whakapapa to the whanau trust. Shareholder Registration No Please ensure your have correctly entered the Shareholders Registration Number on Page 5 of this application. Do not leave this blank or use an incorrect number as your application may be considered incomplete: We advise students to contact the office if shareholder number is unknown. Declaration Declaration must be signed by the Student 9 ACKNOWLEDGEMENT RECEIPT 2015 TERTIARY GRANT NAME: POSTAL ADDRESS: OFFICE USE ONLY Tena Koe Thank you for your grant application. Your application: Has met all requirements and is referred to the Grants Committee for final approval Is incomplete and will not be considered. The reasons are: Did not verify bank account details Did not provide verification of Enrolment Did not provide a copy of the students 2015 fees invoice Did not complete personal statement Did not meet Whakapapa Requirements Did not complete Whakapapa Section Did not sign Declaration Application was received after due date, and will not be considered 10
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