8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 1/21

Aspire Scholarship 2014

Private secondary schools scholarshipapplication form

Completed application forms must be returned to the Ministry of Education byFriday 26 April 2013.

The Aspire Scholarship is for students who would like to attend a New Zealand privatesecondary school and are part of a family with a low household income and net worth (assetminus liabilities). The scholarship contributes up to $!"### per year for private secondaryschool tuition fees and up to $"!## per year for course related costs. lease note it is theresponsibility of the parents%care&ivers to pay for any remainin& school fees over and abovethe contribution from the Aspire 'und.

To apply for the scholarship" please answer all uestions in this application form" provide allreuired supportin& documents" and post to the inistry of *ducation National +ffice by !pmon 'riday ,- April ,# (must be received at the inistry by this time).

lease read all information on this pa&e before proceedin& with the application" and refer tothe Application /uidelines for additional help with the uestions.

A student is eligible for an Aspire Scholarship if:

• they will be in year 9 in ,#0

• their primary care&iver(s) have a combined annual &ross income of$!"000 or less (not includin& 1orkin& 'or 'amilies ta2 credits)

• their primary care&iver(s) have a combined net worth of $200"000 or

less (not includin& household items e.& kitchen appliances and furniture)

• they" or their primary care&iver(s)" are not beneficiaries of any trusts (e2ceptions will be considered on a case by case basis)

• they are a New Zealand citi3en or a permanent resident of New

Zealand.

#efore you apply for an Aspire Scholarship" please be aare that it:

• may not cover all fees and costs at some private schools

• can only be used at the private schools listed on the followin& pa&es

• cannot be used at any state or state4inte&rated schools

• cannot cover boardin& fees.

 Aspire Scholarship ,#0 5 Application form a&e of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 2/21

Private schools compatible ith the Aspire Scholarshipprogramme1

'or further information on each school" please refer to the %inistry’s school directory.

Northland

+tamatea 6hristian School email7 ocschool82tra.co.n3 telephone7 #9 0 :0:;

Sprin&bank School email7 reception8sprin&bank.school.n3  website7 http7%%www.sprin&bank.school.n3 telephone7 #9 0#; !,-

<uanui 6olle&e email7 anna.cronshaw8huanuicolle&e.school.n3telephone7 #9 0!99#

North hore

6ity =mpact 6hurch School email7 ruth.murray8cityimpactchurch.comwebsite7 http7%%www.cityimpactchurch.comtelephone7 #9 0;; ##,

>ristin School email7 admissions8kristin.school.n3website7 http7%%www.kristin.school.n3 telephone7 #9 0! 9!--

?ivin& 1ay ?earnin& 6entre email7 livin&way82tra.co.n3 telephone7 #9 0, ;;,;

inehurst School email7 reception8pinehurst.school.n3  website7 http7%%www.pinehurst.school.n3telephone7 #9 00 #9-#

The 6orelli School email7 admin8corelli.school.n3 website7 http7%%www.corelli.school.n3 telephone7 #9 0;- !#0

1entworth 6olle&e email7 enuiries8wentworthcolle&e.school.n3  website7 http7%%www.wentworthcolle&e.school.n3 telephone7 #9 0,0 ,;

Auc!land

 A6/ arnell 6olle&e email7 parnellcolle&e8ac&edu.com website7 http7%%www.ac&edu.com telephone7 #9 #: ---

 A6/ Senior 6olle&e email7 seniorcolle&e8ac&edu.com website7 http7%%www.ac&.ac.n3 telephone7 #9 #; 00;;

 A6/ New Zealand =nternational 6olle&e email7 office8n3ic.school.n3 

website7 http7%%www.ac&.ac.n3 telephone7 #9 #: -!# Auckland =nternational 6olle&e email7 admissions8aic.ac.n3  

website7 http7%%www.aic.ac.n3 telephone7 #9 #900:#

1 All private" fully re&istered schools that accept students in years 9 @ (includin& secondary schools and some

composite schools) are able to accept the Aspire Scholarship e&cept ilworth School and +dyssey <ouseSchool. ilworth School is not compatible with the Aspire pro&ramme because it does not char&e tuition fees and

+dyssey <ouse School is not compatible because enrolment is only possible on the basis of referral.

 Aspire Scholarship ,#0 5 Application form a&e , of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 3/21

6arey 6olle&e email7 mld8carey.school.n3 website7 http7%%www.careycolle&e.comtelephone7 #9 !;# !:; 

estiny School email7 office8destiny.school.n3 

website7 http7%%www.destinychurch.or&.n3telephone7 #9 !,; ;,

iocesan School 'or /irls email7 admissions8diocesan.school.n3website7 http7%%www.diocesan.school.n3 telephone7 #9 !,# 9,,!

<ebron 6hristian 6olle&e (Auckland) email7 admin8hebron.ac.n3 website7 http7%%www.hebron.ac.n3 telephone7 #9 :0- ,!9

>in&s 6olle&e email7 re&istrar8kin&scolle&e.school.n3 website7 http7%%www.kin&scolle&e.school.n3 telephone7 #9 ,;- #-##

indAlive email7 admin8mindalive.co.n3 website7 http7%%www.mindalive.co.n3 

telephone7 #9 !,9 ;!9,t <obson iddle School email7 admin8mthobson.school.n3  

website7 http7%%www.mthobson.school.n3 telephone7 #9 !, ,0

St 6uthberts 6olle&e (*psom) email7 reception8stcuthberts.school.n3 website7 http7%%www.stcuthberts.school.n3 telephone7 #9 !,# 0!9

The Brid&e Academy email7 mmeyer8ma2net.co.n3 website7 http7%%www.thebrid&eacademy.co.n3 telephone7 #9 !! #!;0

"aita!ere

 A6/ Sunderland 6olle&e email7 enuiries8sunderlandcolle&e.school.n3  website7 http7%%www.sunderlandcolle&e.school.n3telephone7 #9 :: ;#;# 

=mmanuel 6hristian School email7 admin8immanuel.school.n3  website7 http7%%www.immanuel.school.n3 telephone7 #9 :,: 0!0!

N&a >akano 6hristian Ceo Cua >ura email7 n&akakano8ma2net.co.n3 telephone7 #9 :! -,-

Manu!au

 A6/ Strathallan email7 strathallan8ac&edu.com website7 http7%%www.ac&edu.com telephone7 #9 ,9! #:#

 Ambury ark 6entre for Cidin& Therapy email7 office8amburyparkcentre.or&.n3 website7 http7%%www.amburyparkcentre.or&.n3% telephone7 #9 -0 #;-

rury 6hristian School email7 drury82tra.co.n3 telephone7 #9 ,90 ;,

ukekohe 6hristian School email7 pcschool82tra.co.n3 website7 http7%%www.pcschool.co.n3 telephone7 #9 ,: -009

St >enti&ern 6olle&e (akuran&a) email7 admin8skc.school.n3 website7 http7%%www.saintkenti&ern.com telephone7 #9 !;; #;09

Tyndale ark 6hristian School email7 admin8tyndalepark.school.n3  website7 http7%%www.tyndalepark.school.n3

telephone7 #9 ,;0 9;; 1estmount School email7 admin8westmount.school3one.net.n3  

telephone7 #9 -- ,!!

 Aspire Scholarship ,#0 5 Application form a&e of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 4/21

'ai(ato

<amilton 6hristian School email7 admin8hamiltonchristian.school.n3  website7 http7%%www.hamiltonchristian.school.n3 telephone7 #; :!0 ###

St aulDs 6olle&iate (<amilton) email7 c.luman8stpauls.school.n3 website7 http7%%www.stpauls.school.n3% telephone7 #; 9!; ::99

St eterDs School (6ambrid&e) email7 stever8stpeters.school.n3 website7 http7%%www.stpeters.school.n3 telephone7 #; :,; 9:99

#ay of $lenty

Can&itaiki =ndependent School email7 admin8ran&itaiki4ind.school.n3  website7 http7%%www.ran&itaiki4ind.school.n3 telephone7 #; #: 99#

"han%anui

St ominics 6olle&e email7 stdominic8ssp2.com telephone7 #- 00 :0

&a'!e(s #ay

<ohepa <ome School (Napier) email7 schooladmin8hawk.hohepa.or&.n3  telephone7 #- :00 ,;0#

"ellin%ton6hilton St Eames School email7 info8chilton.school.n3 

website7 http7%%www.chilton.school.n3 telephone7 #0 !-- 0#:9

<utt Falley 6hristian School email7keastm8wellin&tonchristianschools.or&.n3 website7http7%%www.wellin&tonchristianschools.or&.n3 telephone7 #0 !-0 :!!,

Gueen ar&aret 6olle&e email7 administration8mc.school.n3  website7 http7%%www.mc.school.n3 telephone7 #0 0; ;-#

Samuel arsden 6olle&iate School email7 Ho.sherlock8marsden.school.n3 website7 http7%%www.marsden.school.n3 

telephone7 #0 0;- :;#;Samuel arsden 6olle&iate School 41hitby

email7 whitby8marsden.school.n3  website7 http7%%www.marsden.school.n3 telephone7 #0 ,0 #;#

Scots 6olle&e email7 bertramm8scotscolle&e.school.n3 website7 http7%%www.scotscolle&e.school.n3 telephone7 #0 :: #:!#

"est Coast

/loriavale 6hristian 6ommunity School email7 school8&loriavale.co.n3telephone7 # ;: #,-!

 Aspire Scholarship ,#0 5 Application form a&e 0 of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 5/21

)hristchurch

6hristDs 6olle&e email7 re&istrar8christscolle&e.comwebsite7 http7%%www.christscolle&e.com telephone7 # -0 -:-

Can&i Curu /irlsD School email7 office8ran&iruru.school.n3 website7 http7%%www.ran&iruru.school.n3 telephone7 # 9: ;##

St AndrewDs 6olle&e (6hristchurch) email7 reception8stac.school.n3 website7 http7%%www.stac.school.n3 telephone7 # 90# ,###

St ar&aretDs 6olle&e email7 admin8stmar&arets.school.n3 website7 http7%%www.stmar&arets.school.n3% telephone7 # ;9 ,###

 Aspire Scholarship ,#0 5 Application form a&e ! of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 6/21

Privacy statement

The personal information in this application is bein& collected by the inistry of *ducation forthe purpose of considerin& your application for an Aspire Scholarship. The information will be

used only for the purpose of considerin& the application" administerin& the scholarship if theapplication is successful" and for statistical and research purposes.

The inistry will share information with others only if this is necessary for carryin& out thepurposes outlined above.

The identities of all applicants will remain protected by the inistry" and will not be releasedto the &eneral public.

The information collected is held by the *ducation" 6urriculum and erformance team"inistry of *ducation and you have the ri&ht to access and reuest a correction of thisinformation.

 Aspire Scholarship ,#0 5 Application form a&e - of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 7/21

Student details

1* +ame of

student

1a* 'irst name(s)  1b* ?ast name  1c* +ther last name student

known by (if applicable)

 

2* ,ate of birth   -*.ender

(lease circle

or underline)'emale ale

Day Month Year  

4* /thnicity(lease circle" underline or tick beside the studentDs most appropriate ethnicity cate&ory)

6hinese 6ook =sland Iori 'iHian =ndian

New Zealand

*uropean%IkehI

Niuean New Zealand Iori Samoan

South *ast Asian +ther Asian Tokelauan Ton&an

+ther *uropean +ther acific =slander +ther (please state)7

* i affiliations

(lease list ifappropriate)

 

!* 3esidency 

(lease circle or underline the studentDs residency cate&ory and provide verification of this,)

New Zealandciti3en

ermanent residentof New Zealand

+ther 

2 Attach a copy of the studentDs birth certificate or passport. Jou do not need to &et this si&ned by an authorisedperson.

 Aspire Scholarship ,#0 5 Application form a&e ; of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 8/21

Schooling details

7* 1ill the student be in year 9 in

,#0K (lease circle or underline)

Jes Nolease note that if you answer no"this student is not eli&ible for the,#0 Aspire Scholarship.

8* 1hich school does the student currentlyattendK• If the student is not currently attending school,

 please state the school they most recentlyattended.

• If the student is homeschooled, please indicate.

 

 Aspire Scholarship ,#0 5 Application form a&e : of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 9/21

)aregiver details

9* <ow many primary care&ivers does this student haveK

(lease indicate in the bo2 to the ri&ht)Primary caregivers include:

• all step parent(s)" &uardian(s) and relative(s) who live in thestudentDs household and act in the place of a parent

A+,• all step parent(s)" &uardian(s) and relative(s) who do not

live in the studentDs household" but share full financialresponsibility for the student.

 Any care&ivers who pay child support money for the student" buthave no other financial responsibility for the child" do not need tobe listed as a primary care&iver.

)etails for first primary care%i*er(The primary care&iver who will make the statutory declaration)

10* Name  11* Celationship to student  12* +ccupation  

1-* <omeaddress

1-a*Streetaddress

 

1-b* suburb   1-c*

6ity

1-d*

ostcode

14* ostaladdress

 (=f differentfrom above)

 

1* hone numbers 1a* <ome (  ) 4

1b* 1ork (  ) 4

1c*obile(s)

(  ) 4

1!* *mail address7  econd primary care%i*er details +if applicable,

17* Name  18* Celationship to student

 19* +ccupation  

 Aspire Scholarship ,#0 5 Application form a&e 9 of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 10/21

 Aspire Scholarship ,#0 5 Application form a&e # of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 11/21

amily income

Employment

20* lease indicate for each primary care&iver whether they are employed" self employed orunemployed7

20a* irst primary care&iver7 *mployed Self4employed Lnemployed

 20b* =f you circled Self employed;" pleaseprovide details of the business in the bo2provided and attach your ,#%,financialstatements.

 

20c* Second primary care&iver7 *mployedSelf4

employedLnemployed N%A

20d* =f you circled Self employed;" pleaseprovide details of the business (if differentfrom above) and attach your ,#%,financial statements0.

 

20e* <hird primary care&iver7 *mployedSelf4

employedLnemployed N%A

20f* =f you circled Self employed;" pleaseprovide details of the business (if differentfrom above) and attach your ,#%,financial statements!.

 

2010-11 income +in Ne' ealand dollars,

lease declare the total &ross income earned in the ,#%, financial year ( April ,# @ arch ,#,) for each primary care&iver. <his does not include 'or(ing or amiliesta& credits*

21* 'irst primary care&iver -7 $

22* Second primary care&iver (if applicable);7 $

2-* Third primary care&iver (if applicable):7 $

<=<A>: $

3 Attach your 2011/12 financial statements for this business.

4 Attach your 2011/12 financial statements for this business.

5 Attach your 2011/12 financial statements for this business.

6 Attach a 2011/12 summary of earnings or notice of assessment from Inland Revenue IR!"# or an income

assessment from $or% and Income# for this caregiver.&

 Attach a 2011/12 summary of earnings or notice of assessment from Inland Revenue IR!"# or an incomeassessment from $or% and Income# for this caregiver# if a''licable.( Attach a 2011/12 summary of earnings or notice of assessment from Inland Revenue IR!"# or an income

assessment from $or% and Income# for this caregiver# if a''licable.

 Aspire Scholarship ,#0 5 Application form a&e of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 12/21

/educed or increased household income since 31 March 2012

24* <as your total household income reduced"increased" or stayed appro2imately the samesince the end of the ,#%, financial year (

arch ,#,)K (lease circle or underline)

Ceduced =ncreased Stayed the

same

24a* =f you circled stayed the same;" pleasemove to 5uestion 2!*

 

24b* =f you circled reduced;" please e2plain why"in the bo2 to the ri&ht.

 

24c* =f you circled increased" please e2plainwhy" in the bo2 to the ri&ht.

 

24d* lease indicate what your reduced orincreased total household income is now andprovide verification of this9.

 

24e* =f you circled Mreduced; in 5uestion 2" do you anticipate thatyour household income will return to its ori&inal level in the comin&yearK 'or e2ample" if you have Hust left your current employment" do you

intend on workin& at the same level in the ne2t year K

(lease circle or underline)

Jes No

24f* =f you answered 5uestion 24e" please e2plain why. +therwise" &o to 5uestion 2.

 

) Attach su''orting documents if income has reduced or increased since the end of the 2011/12 financial year

for any 'rimary caregivers. *u''orting documents could include a letter from an accountant# 'aysli's or a letter

from an em'loyer.

 Aspire Scholarship ,#0 5 Application form a&e , of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 13/21

Additional income

2* oes anyone other than the studentDs primarycare&ivers provide financial assistance for thisstudentK (lease circle or underline)

Jes No

2a* =f yes" please indicate who by circlin& or underlinin& all that apply" below.

=f no" &o to 5uestion 2!.

'ather /randparents +ther

family%whInau

+ther

(lease state)7

2b* lease e2plain7

i. the type(s) of financial assistance that is provided" for e2ample" compulsory childsupport or voluntary payments etc and

ii. how much financial assistance the stated person%people provide per ee(.

i.  4444444444444444444444444444444444444444444444

ii.  

2!* 1as any other  additional income received by the studentDsprimary care&iver(s) durin& the ,#%, financial year other thanthat already mentioned" above#K

Jes No

2!a* =f yes" please list eachsource of income" and thetotal amount received durin&the ,#%, financial year.

Source(s) of =ncome7 Totalincomeamount(s)

  $

$

$

10 Attach documentation to verify additional income# if a''licable.

 Aspire Scholarship ,#0 5 Application form a&e of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 14/21

amily net orth(=n New Zealand dollars)

27* o you own any propertyK (lease circle or underline)

lease note that if you share ownership of a property" the full valueof the property must still be declared (in 5uestion 29) unless youhave le&al verification that shows proportionate ownership.

Jes No

27a* =f no" please move to 5uestion 28. =f yes" please indicate howmany properties you own in the bo2 to the ri&ht.

 27b* lease e2plain whateach property is used for.

 

28* o you rent the property you live inK

(lease circle or underline)Jes No

29* lease add the dollar value of all specified assets and debt that you have" in the table

below. lease fill in every bo& and write M#D (3ero) if the value is # (nothin&).

lease also note that you may only include store card and credit card debt that was current

between 4 +ovember 2012 and ! ?anuary 201-. 'or e2ample" if you have used your credit

card for e2penses after - Eanuary ,#," you cannot add this debt to the table.

Assets @alue >iabilities #alance

29a* 6ash (includin& termdeposits and funds held insavin&s accounts)

$ 29f* Total amount owin& onany mort&a&e(s), $

29b* Total value of all propertyowned as verified by a GuotableFalue (GF) ratin& or a 6ouncilCatin& Falue (CF)

$ 29g* Total amount owin& oncars" boats" and%or anyrecreational vehicles0

$

29c* Total market value of anybusiness interests

$ 29h* Total amount owin& onstudent loans!

$

29d* Total resale value ofvehicles" boats and%or other

recreational vehicles

$ 29i* Amount owin& on creditcard(s)-

$

29e* Total value of investments $ 29* Amount owin& on storecard(s);

$

<=<A> ASS/<S $ <=<A> >A#></S $

11 If yes# attach a co'y of your tenancy agreement or a letter from your landlord confirming your tenancy.

12  Attach mortgage statements for any 'ro'erty# dated no earlier than +ovember 2012.

13  Attach a current ,uotable -alue ,-" rating or a ouncil Rating -alue R-" for any 'ro'erty oned.

14  Attach relevant verification.

15  Attach relevant verification.

16  Attach relevant verification# dated beteen 4 November 2012 and 6 January 2013.

1&  Attach relevant verification dated beteen 4 November 2012 and 6 January 2013.

 Aspire Scholarship ,#0 5 Application form a&e 0 of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 15/21

Jou must provide verification of7

• all property (GF%CF statements)

• all mort&a&es

• all debt 

<owever" you do not need to provide verification for assets other than property @ you must

 Hust describe them" below.

-0* lease describe any other assets that you declared in 5uestions 29a" 29c" 29d" 29e for

e2ample" if you declared a car in uestion #d" provide the make of the car etc.

-0a* <ype of asset:  -0b* ,escription: (e.&.

what the item is" themake of the item etc.)

 

-0c* <ype of asset:  -0d* ,escription: (e.&.

what the item is" the

make of the item etc.)

 

-0e* <ype of asset:  -0f* ,escription: (e.&.

what the item is" the

make of the item etc.)

 

-0g* <ype of asset:  -0h* ,escription: (e.&.

what the item is" the

make of the item etc.)

 

-0i* <ype of asset:  -0* ,escription: (e.&.

what the item is" the

make of the item etc.)

 

 Aspire Scholarship ,#0 5 Application form a&e ! of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 16/21

<rusts=f the student and%or their care&ivers are beneficiaries of any trusts" the student is not eli&iblefor the Aspire Scholarship. <owever" this criterion can be waived if the applicant makes an

acceptable case for doin& so. 'or e2ample" if a student is a beneficiary of a trust but willnever receive more than $## for school books per year from the trust" the criterion can bewaived. But" for e2ample" if the student and%or care&iver is a beneficiary of a family trust" andthere is a property in the trust with a current net worth value e2ceedin& the $,##"### networth eli&ibility threshold" the criterion would not be waived.

-1* =s the student and%or any of the studentDs primary care&iversbeneficiaries of any trustsK (lease circle or underline) Jes No

=f no" please move to 5uestion -2* =f yes" please describe (below)7

-1a* how many trusts  -1b* what type of trust(s)these are:

 

-1c* the total value ofany assets in thetrust(s)9

 

-1d* the total incomereceived from the trustdurin& the ,#%,financial year ,#.

 

1( Attach all relevant documentation about these trusts".

1) Attach a ,uotable -alue ,-" rating or a ouncil Rating -alue R-" if these assets" are 'ro'erty.

20 Attach relevant statements verifying this income.

 Aspire Scholarship ,#0 5 Application form a&e - of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 17/21

3efereeslease provide contact details for two referees. The first one may be a selected referee"such as a non4related friend or church member. The second one must be a recent teacher

(or another selected referee" if the student is currently homeschooled).The inistry of *ducation may make contact with these individuals to verify any detailsprovided in the application.

irst referee contact details (Any non4related person known to you) 

-2* Name of referee7  --* Celationship to student7  -4* Address7  -* hone numbers7 -a* <ome  (  ) 4

-b* 1ork  -c* obile(s)  

-!* *mail address  Second referee contact details (A recent teacher" or another selected non4related personknown to you if student is currently homeschooled)

-7* Name of referee7  -8* Celationship to student7  -9* Address7  40* hone numbers7 40a* <ome (  ) 4

40b* 1ork  40c* obile(s)  

41* *mail address7  

 Aspire Scholarship ,#0 5 Application form a&e ; of ,

ave you ansered every 5uestion on this page6

f not" your application may not be accepted*

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 18/21

Statutory declaration(ust be handwritten)

<his statutory declaration must be itnessed by a solicitor" a ?ustice of the Peace" a)ourt 3egistrar" or other person authorised to ta(e a statutory declaration.

="

(full name of primary care&iver)

of"

(home address)

solemnly and sincerely declare that the information = have provided in this application istrue and correct.

= make this declaration conscientiously believin& the same to be true and by virtue of the+aths and eclarations Act 9!;.

Si&nature

eclared at

(town%city%district)

ate

+fficial witness name" in full

Si&nature of witness

+ccupation of witness

 Address of witness

There are penalties under the 6rimes Act for providin& false information and provision offalse information will also result in the termination of the scholarship.

The inistry may audit applications at random" or if there is any reason to su&&estinformation in an application is inaccurate.

 Aspire Scholarship ,#0 5 Application form a&e : of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 19/21

)hec(list

6ompleted application forms must include the followin&7Tick ( "

or  markM+AD (Not Applicable)

1*  A copy of the studentDs birth certificate or  passport.

2* ,#%, financial statements for any businesses that the studentDs primarycare&ivers have a financial interest in" if applicable.

-* +ne of the followin& for every primary caregiver:

  (including caregivers who did not earn anything )

a. a ,#%, summary of earnin&s from =nland Cevenue (=C)

b. a notice of assessment from =nland Cevenue (=C)

c. an income assessment from 1ork and income.

4* Supportin& documents if income has reduced or increased since the endof the ,#%, financial year ( arch ,#,) for any primary care&ivers"if applicable.

* ocumentation to verify any additional income received in thehousehold(s) that the student lives in (not includin& 1orkin& 'or 'amiliesta2 credits)" if applicable*

!*  A copy of your tenancy a&reement or a letter from your landlord" if yourent a property*

7* ort&a&e statements dated no earlier than November ,#, for anymortgages held*

8*  A current Guotable Falue (GF) ratin& or  a 6ouncil Catin& Falue (CF) foranyBall property oned*

9* ocumentation to verify all other debt%liabilities declared.

10*  A Guotable Falue (GF) ratin& or a 6ouncil Catin& Falue (CF) for anyproperty owned by any associated trusts" if applicable.

11* Celevant statements verifyin& any income received from any associatedtrusts durin& the ,#%, financial year.

12*  Any other  relevant documentation about any associated trust(s)" ifapplicable*

1-*  A statutory declaration si&ned by a primary care&iver" in front of a personwho is authorised to witness a statutory declaration (such as a Hustice ofthe peace" a solicitor or a court re&istrar).

 Aspire Scholarship ,#0 5 Application form a&e 9 of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 20/21

'here to send completed applications

6ompleted applications must be received at the inistry of *ducation National +ffice by7

*00 pm on riday 2! April 201-inistry of *ducation National +fficePostal Address7

inistry of *ducation National +fficePhysical Address7

 Aspireinistry of *ducation+ Bo2 ---1ellin&ton -0#

inistry of *ducation?evel % 0! @ 0; ipitea StreetSt aulDs SuareThorndon1ellin&ton -#

 Applications will only be accepted by post* Applications will not be accepted if they areemailed or fa2ed.

 Applications received after !pm on ,- April ,# will not be accepted" even if they havebeen posted before this date. Jou can courier or hand deliver your application if necessary.

 Aspire Scholarship ,#0 5 Application form a&e ,# of ,

8/12/2019 2014 Aspire Applicationform

http://slidepdf.com/reader/full/2014-aspire-applicationform 21/21

Advertising research

1here did you first hear or read about

the Aspire ScholarshipK

=f it was in a nespaper " please indicate whether it was in one of the followin&newspapers by underlinin& or tickin& the appropriate caption.

 Auckland 6ity<arbour News

The 6entral istrictTimes

6entral ?eader The 6hristchurch ail

unedin Star *ast Bays 6ourier *astern 6ourier   'ranklin 6ounty News

<amilton ress <astin&s ?eader <orowhenua ail <utt News

>api4ana News >apiti +bserver anukau 6ourier Napier 6ourier  

North 6anterburyNews

North Shore Times apakura 6ourier Codney Times

Cotorua Ceview Lpper <utt ?eader 1aihekearketplace

1airarapa News

1an&anui idweek The 1ellin&tonian 1estern ?eader   +ther (lease state)7