Ann Sinclair Trust
Tertiary Evaluation Form
Region you come from
*
Please Select
Taranaki
Manawatu-Whanganui
Wellington-Wairarapa
Student Full Name
*
First Name
Last Name
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
Back
Next
Save
Course Name
*
Course Provider Name
*
Course Length
*
How many months/years of study to complete the course/training
Year of Study
*
1st Year
2nd Year
3rd Year
4th year
Year the grant was spent
*
Your evaluation of the grant you received
(i.e. how did the grant(s) benefit you?)
What is the next step in your life?
(work and/or further study)
Course Completed?
*
Yes
No
Back
Next
Save
Grants received from Ann Sinclair Trust:
Back
Next
Save
Authorised Person
I confirm that the information in this grant evaluation form is correct and that I acknowledge that I have received a grant from the Ann Sinclair Charitable Trust (administered by Presbyterian Support Central).
Name
*
Signature
*
Date of Evaluation
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Save
Submit
Should be Empty: