Financial Hardship Questionnaire
Te Piringa – Faculty of Law Endeavour Scholarship
CONFIDENTIAL
Y
O U R
P
E R S O N A L
D
E T A I L S
NA ME A N D ID
Full name:
University of Waikato student ID:
C O NTA C T D ET A I L S
For correspondence regarding this questionnaire
Street number and name:
Suburb:
Town/City:
Telephone:
(daytime)
E-mail:
B
A C K G R O U N D
Telephone:
Mobile:
I
N F O R M A T I O N
PER SO NA L C I R C U M STA NC ES
Please tick the appropriate boxes
How will you support yourself at University?
Student allowance
Bank loan
Student loan
WINZ benefit
Bank overdraft
Parental support
Employment
Other (e.g. Grants received or other
support)
What will your living arrangements be?
Halls of Residence Self-catered
Living of Campus (e.g. Home, Flatting)
Halls of Residence Fully catered
(evening)
Financial Hardship Questionnaire
Te Piringa – Faculty of Law Endeavour Scholarship
What is your anticipated weekly budget?
INCOME
$
Source
$
Source
$
Source
$
Source
TOTAL INCOME (A)
$
EXPENSES
$
Board
$
Food
$
Power and gas
$
Phone
$
Transport
$
Loan or HP repayments
$
Insurance
$
Personal & entertainment
$
Other (please specify)
TOTAL EXPENSES (B)
$
CREDIT/DEFICIT (A – B)
$
What is your proposed course of study?
Faculty/School:
Proposed major:
Qualification:
Number of papers enrolled in:
Do you currently have regular employment?
Yes
No
What employment have you had in the last 12 months?
Position
Full- or parttime
From
To
Total Earnings
$
$
$
Financial Hardship Questionnaire
Te Piringa – Faculty of Law Endeavour Scholarship
FA M I LY C IR C U M ST A NC ES
What are your parents’ circumstances?
Father
Mother
Occupation:
Current employer:
Years employed:
Previous employer:
Years employed:
Annual gross income:
Please attach supporting documentation.
What assets do you and your parents own?
VALUE
MORTGAGE (still owed)
House
$
$
Vehicle(s)
$
$
Savings/Investments
$
$
Other
$
$
If your parents rent the home you live in:
Who do they rent from?
How much do they pay in rent per week?
$
What support do you obtain from parents, relatives, or friends?
Is there any person or organization currently providing you with financial support?
Yes
If ‘Yes’, please indicate the amount of this support.
Name of organization, if applicable:
No
$
Per week/month/year (circle one)
Financial Hardship Questionnaire
Te Piringa – Faculty of Law Endeavour Scholarship
Please briefly outline your current concerns and your reasons for financial hardship, e.g. family
responsibilities/situation, social or economic background, etc.
A TTA C H M E NT S
The following documentation is required before your application can be processed:



Most recent month’s bank statement
Current bank balance
Other supporting documentation showing the family’s financial position
D E C L A R A T I O N
I certify that the information in this questionnaire is correct and that no information which could have a material
bearing on my application has been withheld.
I authorize the University of Waikato Student Finance Advisor to seek additional financial information relevant
to the processing of this application from my parents/guardian/family.
S
I G N
Signature:
H E R E
Date: