ENDEAVOUR SCHOLARSHIPS
Application for Entry in Year 7 2018
Please place a
Passport style
photo of
applicant here
Please provide email address for all correspondence related to Scholarship Application process
Surname
Religion
First names
Nationality
Preferred name
Language at home
Date of birth
Country of birth
Present school
NZ residency
Present year level
Ethnic group
The student lives with
both parents
father only
mother only
Yes
No
guardian
Father/Stepfather/Guardian (circle as appropriate)
Mother/Stepmother/Guardian (circle as appropriate)
Title
Title
Surname
Surname
First names
First names
Preferred name
Preferred name
Home address
Home address
Suburb
Suburb
City
City
Postcode
Postcode
Country
Country
Home phone
(
)
Home phone
Postal address
Postal address
(If different from above)
(If different from above)
Postcode
Postcode
Mobile
(
)
Mobile
Business phone
Business phone
Email
Email
Occupation
Occupation
Business name
Business name
Religion
Religion
Parent with whom we should correspond if parents are separated/divorced:
(
)
(
)
Summary of academic and co-curricular interests and achievements
The candidate should submit a one page typed statement about why she wishes to attend St Cuthbert’s College and
what she would contribute to the College.
If your daughter is not offered a Scholarship but there is a fee-paying place available in the College, would you be
interested in her accepting that place? (please tick one)
YESNO
Check list:
we have included the most recent school report
we have included a passport sized photograph
we have included the candidate’s personal statement
we have included documentary evidence of New Zealand birth, citizenship or residency
we have included the form detailing Maori descent or certified copies of documentary evidence of Pasifika descent
we have given the Confidential Report Form to current school
Please send photocopies of documents - we cannot accept responsibility for originals.
Where both parents support this application, two signatures are required:
Father
Mother
Guardian (if applicable)
Date
Where did you hear about St Cuthbert’s College (please tick):
Website
Newspaper
Word of Mouth
Social Media
Other
Closing date for applications
Monday 31 July 2017
No late entries will be accepted
Scholarships only available to New Zealand citizens and residents
The decision of the Principal is final and no discussion will be entered into regarding the scholarship winners.
Please return to:
or email:
The Admissions and Scholarships Office
St Cuthbert’s College
PO Box 26020, Epsom, Auckland 1344
[email protected]
STUDENTS OF MAORI DESCENT - YOU MUST COMPLETE THIS FORM.
STUDENTS OF PASIFIKA DESCENT - YOU MUST PROVIDE COPIES OF DOCUMENTARY EVIDENCE OF PACIFIC
ISLAND DESCENT.
KOROWAI MAORI
What is your Iwi?
What is your Hapu?
What is the name of your Marae?
WHAKAPAPA
You may choose to recite your whakapapa to your Kaumatua / Kuia instead of writing. This should be noted on the
application form.
Koroua
Kuia
Koroua
Matua Tane
Kuia
Whaea
Kaitono
PLEASE INDICATE IF THE WHAKAPAPA WAS PROVIDED ORALLY
KAUMATUA / KUIA SIGNATURE
Date
NGA TIKANGA
Please note your personal involvement in nga take Maori with iwi, hapu and whanau groups, school(s) or other community groups.
ENDORSEMENT
(This must be completed by a Kaumatua/Kuia, an Iwi representative of a Maori authority; Runanga, or Trust Board, a teacher
who is Maori, a leader of a Maori community group e.g. Marae, Church, Maori Women’s Welfare League, and SES Kaumatua
or a Maori Liaison Officer).
You should be known to your endorser.
I endorse this application because:
Endorser’s signature
Designation / Organisation
Endorser’s name
Date