Second Chance Scholarship – Gisborne Business and Professional Women

APPLICANT'S PERSONAL DETAILS

First Name

Middle Name

Last Name

Date of Birth

Phone/Mobile

Address

Address Line 1

Address Line 2

City

Region

Postcode

Email

Citizenship (Tick which ever applies)

NZ citizen

Permanent resident

SECONDARY SCHOOL EDUCATION

Name of school(s)

Years attended

Highest qualification gained at school

OTHER EDUCATION COMPLETED (Tertiary or other)

Name of institution

Years attended

Highest qualification gained

INTENDED EDUCATION (Tertiary or other)

Name of institution

Year starting / ending

Intended qualification

WORK EXPERIENCE

Employer #1

Role Held #1

Dates Employed (to/from) #1

Employer #2

Role Held #2

Dates Employed (to/from) #2

Employer #3

Role Held #3

Dates Employed (to/from) #3

Employer #4

Role Held #4

Dates Employed (to/from) #4

REFEREES – Provide contact details for two references. Ensure they are aware of this application.

Referee Name #1

Referee Relationship #1

Referee Phone/Mobile #1

Referee Email #1

Referee Name #2

Referee Relationship #2

Referee Phone/Mobile #2

Referee Email #2

STUDY COSTS

Fees Costs $

Textbooks Costs $

Other Costs $ (if no other costs enter 0)

TOTAL COSTS $

HOW WOULD RECEIVING THE BPW GISBORNE SECOND CHANCE SCHOLARSHIP HELP YOU ACHIEVE YOUR EDUCATION, CAREER OR PERSONAL GOALS?

WHAT IS YOUR CONNECTION TO GISBORNE TAIRAWHITI? Provide details in less than 400 words

HOW DO YOU HOPE YOUR EDUCATION OR TRAINING WILL ENABLE YOU TO CONTRIBUTE TO YOUR WHĀNAU, WORKPLACE, COMMUNITY OR THE WIDER TAIRĀWHITI REGION?

HOW DID YOU HEAR ABOUT THIS AWARD?

From a BPW Member

Social Media / Facebook

Advertisement via educational institute

BPW Website

Advertisement/Poster in a retail store

Other: please advise

CHECKLIST – Ensure you have the following documentation available if you are selected for an interview

Proof of Citizenship OR Permanent Residence

Academic transcript / grades

Your Curriculum Vitae (CV)

Proof of offer from a tertiary institution

Fully completed this Application Form

Applicant Declaration

I declare that the information supplied in this application is true and correct to the best of my knowledge. By submitting this application, you verify that all information is true and correct.

I understand that any false or misleading information may result in my application being withdrawn.

Privacy Statement:

The information contained in this application will be used solely for the purposes of assessing the BPW Gisborne Second Chance Scholarship and will remain confidential.

BPW Gisborne Second Chance Scholarship Application Form

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