Ann Sinclair Trust
Tertiary Application Form
Did you receive a Grant Last Year?
*
I completed a Grant Evaluation Form for last year’s grant
I did not receive a grant last year
I did not complete a Grant Evaluation Form for last year’s grant and would like to do so now
Click on this link
to access the Evaluation Form for Last Year's Grant
Student Full Name
*
First Name
Last Name
Region you come from
*
Please Select
Northland
Auckland
Waikato
Bay of Plenty
Gisborne
Hawke's Bay
Taranaki
Manawatu-Whanganui
Wellington-Wairarapa
Nelson-Tasman
Marlborough
West Coast
Canterbury
Otago
Southland
Chatham Islands
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Gender
*
Male
Female
Indeterminate/Unspecified
Ethnicity
*
Please Select
NZ European
Māori
Pacific Peoples
Asian
Middle Easten/Latin American/African
Other
Other Ethnicity
*
Contact Address
*
Street Address
Street Address Line 2
City
Region
Post Code
Contact Daytime Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Mobile
*
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email
*
example@example.com
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Course Name
*
Course Provider Name
*
Course Length
*
How many months/years of study to complete the course/training
Other Courses/Study/Training undertaken in Agriculture:
Reason for Studying:
Do you have any farming experience and what is your personal connection to the farming sector?
In 250 words or less please outline what is motivating you to undertake your course of study. (Please refer to the Ann Sinclair Charitable Trust Guidelines)
0/250
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Grants previously received from Ann Sinclair Trust:
Costs and Assistance Sought for Proposed Course:
*
Total Proposed Cost
*
Total Assistance Sought
*
Assistance Already Available
Parent(s)/Guardian(s)/Partner Taxable Income for Past Year
Total Parent/Guardian/Partner Taxable Income
*
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Sources of Funding
Other grants applied for
*
Are there any special circumstances you would like the trustees to be aware of when considering your applications?
*
Alternative if grant declined/reduced
*
Bank Account Number
Format: NN-NNNN-NNNNNNN-NNN
Proof of bank account
*
Browse Files
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Please attach bank deposit slip or other proof of bank account (verified/stamped/signed by bank staff)
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Authorised Persons
Name
*
Signature
*
Date of Application
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
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