This is an application for (please circle): Secondary School Grant Year only $250

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1 Office Use Date Received: Postal address: PO Box 4035; Whanganui 4541 New Zealand Telephone: Fax: Website: Te Ati Hau Trust Education Grant / Scholarships Applicant: Date of Birth This is an application for (please circle): Secondary School Grant Year only $250 Undergraduate qualification Full Time up to $700 Part-time up to $350 High Performance $1,000 Ngā Muka o te Reo Grant $700 Medical Degree Grant Year 1-3 $700 Year 4+ - $1,500 Te Morehu Tangata E ngā uri o te whenua i āta tiakina hei oranga mō ngā uri whakatupu, tēnā koutou Nau mai kia mihia atu te hunga e whai kaha ana ki te kokiri i nga kaupapa, hei oranga mo te iwi Post graduate qualification $1,500 - $3,000 Overseas scholarship $2,000 minimum Agricultural Scholarship $3,000 Ātihau Whanganui Incorporation under graduate scholarship: Ohotū $2,000 Ātihau Whanganui Incorporation Post graduate scholarship: Robin Murphy-Peehi $8,000 each year for 2 years Kāwana Pohe Scholarship for Musical Excellence $6,000 over 2 years TE ATI HAU TRUST DECISION: Amount: $ For ACCEPT DECLINE Chairperson s signature: 1 P a g e

2 The categories for Education grants are: 1. A student enrolled in a course with no fee will receive $150 to support their attendance and other course costs. 2. A secondary school student in year $ A part-time course (academic or industrial) - $350. Part-time is less than 12 hours per week for less than 9 months. 4. A student whose full-time fee is less than $700 will receive the fee only. 5. A full time post-schooling course (academic or industrial) - $700. Full time is at least 12 hours per week for 9-12 months. 6. A student performing at a high standard (no mark lower than a B) will be awarded $1,000 in recognition of high performance and as an encouragement to students to strive for high marks (pro-rata for part-time - $500). 7. The Medical award includes undergraduate nursing courses up to 3 $700. Masters nursing courses are covered in the 3+ years Medical grant of $1,500, along with students studying to be a medical doctor. 8. The post graduate award will now be split: Post graduate up to Masters $1,500 PhD: each year for up to five years $3,000 Please note a recipient of the Robin Murphy-Peehi Atihau Whanganui Incorporation Scholarship (2 $8,000) will be eligible for this award if s/he is not successful in retaining the scholarship. 9. Overseas scholarship $2, Agricultural Scholarship $3, Atihau Whanganui Inc Ohotu Undergraduate x 4 $2, Robyn Murphy-Peehi Post Graduate Scholarship $8,000 x 2 years 14 Kawana Pohe Musical Excellence Scholarship $6,000 x 2 years 2 P a g e

3 Closing dates in any year: 31 March, 30 June, 30 September. The Trust will meet April, July, and October each year to process and decide on applications. Course Provider (school or other): Course: Proposed length of course (yrs) (mths) Year commenced: Proposed completion date: Course hours per week: Course fees Paid $ If you are at school, tell us how you will use the money: If you are attending a course that is post-school (not school but another provider such as UCOL, trade training or University) tell us: A A. Why you are enrolled in this course and B. How our support of you will help you and C. How your participation in this course might help your whanau, hapu and iwi. B C Attach additional comment sheet if require To support your application all applicants that have already completed a tertiary course or part of a tertiary course are required to submit a copy of the official transcript of results for each part of the course completed (no matter the course) all copies must be verified by a lawyer, JP, School Principal or Te Ati Hau Trust Office Staff. Will you be willing to attend a hui of grant and scholarship holders? YES NO Signature of Applicant 3 P a g e

4 Applicant Contact Details Address: Phone Number: Te Ati Hau Trust will use this address to contact you Eligibility Relationship of applicant to Atihau Whanganui Incorporation You will need to get the person from whom you descend who is an Atihau-Whanganui shareholder to verify your relationship. If you are a beneficiary of a Trust or Estate that holds shares in Atihau Whanganui Incorporation you will need to get one of the Trustees or Administrators to verify your status and eligibility I, am a shareholder / Trustee / Administrator that holds shares in the Atihau Whanganui Incorporation. Share No: I hereby certify that is (Tick the most appropriate) My Descendant A beneficiary of the following Trust, named: A beneficiary of the following Estate, named: Signed: Date: / / Witnessed by (this must be someone other than the applicant): Name of Witness: Signature of Witness: Office Address: 4 P a g e

5 Payment in the case of a successful application All Education and Scholarship payments will be made directly to the applicant s bank account. Pre-enrolment applicants will be paid directly after any withdraw date that entitles the student to receive a refund of the enrolment. Withdraw date i.e. the date before which you could withdraw and would be eligible to receive a refund of fees from your education provider Please provide an official deposit slip or electronic copy showing the name of the account, which must be the name of the applicant to ensure no mistakes are made and to verify the account you provide in the box below. Bank Account details: Name of Bank: Account name: Branch Account No: Reporting Successful applicants will be required to submit a progress report on their study or project including a photograph of them for our database. The Te Ati Hau Trust board is genuinely interested in knowing how you are going with your studies or project. Grant and Scholarship recipients will be required to consent to this condition prior to receiving payment of the grant. Grants will be paid on receipt of the recipient s acceptance. Database The Trust invites recipients to provide their personal details for our database e.g. Name, Date of Birth, and contact details. This information will help the trust keep connected to its recipients e.g. send updates on trust activities Please tick this box to give your consent to enter your personal and contact details from this form into Te Ati Hau Trust database. Checklist - Please attach evidence of: Applicant Office All sections of application form completed Your enrolment from your course provider A copy of the course fees receipt showing the amount paid Verified Bank account deposit slip or electronic copy Verified copy of official transcripts of results 5 P a g e