Clone of 2025 Kauri Club Scholarship Application Form

Kauri Club Scholarship Application Form

2025
Contact Details
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Are you currently living in Northland?*

YesNo
If you answered 'no' above, please give details of where and for how long you live away e.g. Away studying in Dunedin for 9 months of the year; Working in Auckland fulltime but I return to represent Northland in my sport etc.
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Ethnicity (tick all that apply)

AsianEuropean/NZ EuropeanMāoriMiddle Eastern, Latin American, AfricanPacific PeoplesOther
Main Sport/Discipline*
How do you prefer to be contacted E.g. Text, Email, Phone?
Parent/Guardian Contact Details

Required if you are aged under 18 years.
Name

First NameLast Name
Email
example@example.com
Cell Phone Number
Coach Contact Details
Name*

First NameLast Name
Email*
example@example.com
Cell Phone Number*
Employment & Education Status
Are you employed?*

NoCasualPart-timeFull-timeOther
Please give details - Days/hours etc
Are you studying? (Tertiary)*

NoPart-timeFull-time
Please give details
Are you at school?*

YesNo
If yes, what school and year level?
Performance/Competition Information

Please supply the following performance results where applicable:
Are you currently eligible to represent Northland in your chosen sport?*

YesNo
If you answered 'no' above please explain why.
Will you be representing Northland in your chosen sport for the next 12 months?*

YesNoNot sure
If you answered 'no or not sure' above please explain why.
International:

Result (please indicate team or individual, specific event and placing)
2025:
2024:
New Zealand Open/ Open Nationals:

Result (please indicate team or individual, specific event and placing)
2025:
2024:
New Zealand Age Groups:

Result (please indicate team or individual, specific event and placing)
2025:
2024:
New Zealand Secondary Schools:

Result (please indicate team or individual, specific event and placing)
2025:
2024:
Northland Championships:

Result (please indicate team or individual, specific event and placing)
2025:
2024:
Ranking
Current NZ Ranking:
Current Age Group Ranking:
If you are apart of any National squads, development programmes, High Performance Sport NZ programmes etc please list them below:
Any other performance results or relevant information from the past couple of years:
Sporting Goals
Briefly outline your sport/performance goals - short term 1 yr:*
Briefly outline your sport/performance goals - long term 3 yrs+:*
What do you believe are your major strengths that will assist in achieving these goals?*
What do you believe are your major weaknesses or barriers to achieving these goals? *
Performance Planning
What are your major competitions in the next 12 months? Please list locations and dates where possible:*
What are the dates and length of your competitive season? *
Performance Services & Support
What support do you receive from your Regional Sports Organisation or National Sports Organisation with development, training, coaching, competitions etc?

Example 1 –Sarah’s sport is hockey. She is part of the Hockey Northland Rep Team and receives gym/training support 2 x a week, physio services and a general nutrition plan.

Example 2 – John is on the NZ Squash Junior Development Squad. He attends 2 x development camps a year, has a training/gym programme to follow from Squash NZ, receives nutrition advice etc.
Please describe support received below:*
List any other awards and/or scholarships you are receiving or have applied for to support your performance and training programme:*
Outline why you should be granted a Kauri Club Scholarship and explain how you demonstrate your commitment to excellence:*
Financial
If you were successful with the scholarship, outline what support and development support/services you think you would like to use your scholarship for? Remember 75% is for development services, 25% for other things like travel & gear.*

Detail costs below for how you might utilise your scholarship grant e.g. travel to competitions, fees, coaching, equipment, support services etc. Remember 75% is to go towards development support & 25% to other things such as travel and competitions:*

	Description/What:	Cost $:
Item
Item
Item
Item
Item
Item
Item
Item
Total Cost $:

Declaration
Athlete

In submitting this application, I certify that the information provided is accurate and complete.
Athlete Signature*

Clear
If Under 18 years
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date*

MonthDayYear
Date
Coach Support Information
Have you sent your Coach Support Information online form to your coach? (this is required for your application to have this information)*

They are completing the online formNo
Your Privacy:

Sport Northland and the Northland Sports Talent Development Panel, will record the personal details that are provided on this application form in order to fully consider your application. This information may only be accessed by Sport Northland and the Northland Sports Talent Development Panel personnel. You have the right to inspect and update your details at any time. Please contact Sport Northland Ph (09) 4379600.
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Kauri Club Scholarship Application Form

Contact Details

Parent/Guardian Contact Details

Coach Contact Details

Employment & Education Status

Performance/Competition Information

International:

New Zealand Open/ Open Nationals:

New Zealand Age Groups:

New Zealand Secondary Schools:

Northland Championships:

Ranking

Sporting Goals

Performance Planning

Performance Services & Support

Financial

Declaration

Athlete

If Under 18 years

Coach Support Information

Your Privacy: