Proof of engagement declarations must be submitted
for approval between the 2nd of October and 30th of
November 2017
Kā Pūtea
Proof of Engagement Declaration
If you have any queries, or for assistance completing this
application form, please phone 0800 KAI TAHU or email
[email protected]
As part of the changes to the Kā Pūtea Grant we can provide pathways for
you to learn, connect and engage with Ngāi Tahutanga.
• Year 1 is based around engagement. This may involve completing a
simple online course, pronunciation or learning your pepeha. *
• Year 2 is around connections. This may involve learning about Ngāi
Tahu history, the settlement and connecting with your papatipu
rūnanga. *
• Year 3 and subsequent years is around giving back to the iwi. This is an
extension of the connections that have been formed and how whānau
can use this to contribute back. *
* See links provided on our website at www.ngaitahu.iwi.nz/kaputea
To be successful you will need to meet these criteria.
SECTION 1: PERSONAL INFORMATION
Ngāi Tahu Registration No:
Postal Address:
First Names:
Post Code:
Surname:
Date of Birth:
Country:
Occupation:
Residential Address (if different from postal address):
Phone (wk):
Phone (hm):
Mobile:
Fax:
Email Address:
Male
Female
SECTION 2: BANK ACCOUNT DETAILS
Please tick if you would like your grant payment(s) deposited into your Whai Rawa account.
If not please ensure a pre-printed, or bank verified deposit slip or current bank statement is attached below
TE RŪNANGA O NGĀI TAHU USE ONLY
Date Received
Date Complete
Date paid
Amount
Authorised by
1
PLEASE COMPLETE ALL SECTIONS
SECTION 3: PROOF OF ENGAGEMENT
Please provide proof of your engagement, complete one of the following options:
OPTION A: PROOF OF ENGAGEMENT
Please attach a copy of your proof of engagement. This may include a certificate, official letter or confirmation from your marae that you have
completed a form of engagement outlined on the Kā Pūtea website.
YES - I have attached proof of engagement
NO - please have your tertiary institution/supervisor complete Option B
OPTION B: PROOF OF ENGAGEMENT
Please have your tertiary institute/supervisor complete the
following:
Student’s Full Name
Full Name of Course/Event
Name of Tertiary Institution or Event Co-ordinator
Provide a short description of the role the student
filled (if applicable)
Start Date:
D
D
M M
2
0
1
End Date:
7
D
D
M M
OPTION B: INSTITUTION STAMP AND SEAL
OPTION B: CERTIFIER’S DECLARATION
I,
(Certifier’s Name)
of
(Institution)
am certifying the applicant’s study details.
Signature:
Contact Number:
(Certifier’s Signature)
Date:
D
D
M M
2
0
1
7
2
0
1
7
PLEASE COMPLETE ALL SECTIONS
SECTION 4: APPLICANT DECLARATION
Reciprocity Clause
Recipients will be asked to link back, where possible, to their rūnanga and/or to undertake project work for Ngāi Tahu iwi.
Declaration
•
•
•
•
•
•
•
•
I consent to Te Rūnanga o Ngāi Tahu seeking further information from 3rd parties to assist in processing this application.
I certify that all information supplied in this application is true and correct.
I consent to this information being made available to Te Rūnanga o Ngāi Tahu for statistical purposes.
I consent to making myself available for participation in Ngāi Tahu or other iwi endorsed programmes.
I consent to information contained in this application, including my presentation and/or photo, being used for tribal publications.
I give consent to Te Rūnanga o Ngāi Tahu to maintain a permanent record of my presentation on fil .
I understand that this application form maybe destroyed once the application process is complete.
I consent to receiving electronic messages in relation to this application from Te Rūnanga o Ngāi Tahu and associated entities.
Before signing and posting this application form, please take a moment to check that the following have been included. Failure to include all
relevant information may result in the processing of your application being delayed or declined. Signing and dating this section confirms
you have read and understand conditions above.
NB: All sections must be fully completed before the application can be processed.
Signature:
Date:
DD
MM
YYYY
KĀ PŪTEA PROOF OF ENGAGEMENT CHECK LIST
Section 1 is complete
Section 2 is complete - a preprinted, or bank verified
deposit slip or current bank
statement attached.
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Section 3 is complete
Section 4 is complete
Send your application to:
Kā Pūtea Scholarships & Grants
Te Rūnanga o Ngāi Tahu
Po Box 13-046
Christchurch 8141
4