Mary Adeline Allen Scholarship Application

Mary Adeline Allen Scholarship Application
Purpose: The Mary Adeline Allen Scholarship was established for the purpose of assisting a Deaf or Hard of Hearing child (children) in obtaining education or vocational training in New Zealand up to the age of 20. There is no requirement that the recipient be enrolled as a current pupil of Ko Taku Reo.

Scholarship Value: Determined annually by The Public Trust
Notes:

* Applications close annually on 15 November for the following year.
* Applications to be reviewed, and interview held (if applicable) with the selection made by the Executive Principal on 29 November.
* Applicants notified of their application outcome. (successful or unsuccessful) within one week by the Executive Principal. (or delegate)
* Scholarship funds paid by Ko Taku Reo directly to the Tertiary Education Provider on receipt of an appropriate GST course fees invoice.

* There will be some mandatory attachments to attach at the end of the form.

* Phone number is requested.

* You can save your form and come back later and submit if required.

Personal Information
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred method of communication?*

PhoneTextEmail
Phone Number*
Can be landline, mobile number - can be either for text or calling.
Email Address*
example@example.com

Personal Statement
Please provide abrief statement (up to 300 words) explaining why you deserve the Mary Adeline Allen Scholarship. Include your career aspirations and how this scholarship will help you achieve your goals.*

References

Please provide the name and contact details of one referee who can attest to your academic abilities and character.
Referee's Name*

First NameLast Name
Relationship to Applicant*
Preferred method of communication?*

PhoneTextEmail
Phone Number*
Can be landline, mobile number - can be either for text or calling.
Email Address*
example@example.com

Attachments
Checklist – please attach the following with your completed application form:

* A recent character reference (no more than 3 months old)
* A copy of the offer of placement to study from an approved education or vocational training provider
* A recent photograph (head and shoulders)
* A copy of your NZQA academic record
* Any other information you think would support your application
A recent character reference (no more than 3 months old)*

Cancelof
A copy of the offer of placement to study from an approved education or vocational training provider

Cancelof
A recent photograph (head and shoulders)*

Cancelof
A copy of your NZQA academic record*

Cancelof
Any other information you think would support your application

Cancelof

Declaration
Please tick if you agree to the declaration?*

I agree to the declaration.
Date*

DayMonthYear
Today's date.
I hereby declare that the information provided in this application is accurate and complete to the best of my knowledge. I understand that the Mary Adeline Allen Scholarship may be withdrawn if any information is found to be false.
Should be Empty:

Personal Information