2015 BOARDING SCHOOL GRANT APPLICATION FORM
CLOSING DATE: Friday, 27 February 2015 at 4.00pm
PLEASE SEND APPLICATIONS TO:
Physical Address: Omataroa Rangitaiki No 2 Trust
Te Wairere House
6 Wairere Street
Whakatane
Postal Address: PO Box 227
Whakatane
Contact Info:
Telephone (07) 929 5690
Email: [email protected]
POLICY:
Trustees will consider applications for a grant from persons who satisfy BOTH of the following Criteria:
1. You must be a current owner or the NATURAL ISSUE of an owner
2. You are enrolled in Year 9 or above at a Recognised Secondary Boarding School as a FULL TIME student
OFFICE USE ONLY:
Date Received:
/
/
Applicants First Name:
Last Name:
Enrolment Verified:
Yes
No
Invoice Attached:
Yes
No
Boarding Hostel Verified:
Yes
No
Bank Account Verified:
Yes
No
Shareholder Verified
Yes
No
Yes
No
Shareholder Name:
Registration Completed:
Comment:
Page 1 of 8 Omataroa Rangitaiki 2 Trust
SECTION 1: APPLICANT DETAILS
First Name:
Middle Name:
Surname:
Gender:
Male
Female
Yes
No
Age
Academic Year
Natural Issue:
If No:
Is Biological parent a shareholder or Beneficiary of Omataroa Rangitaiki No 2 Trust:
Shareholders Name:
SECTION 2: PARENTS POSTAL ADDRESS
Name:
Postal Address:
Post Code:
Cell phone No:
(
)
Phone (Day):
(
)
Email Address:
INVOICE: (The grant is to assist with accommodation costs associated with Boarding Schools)
Please attach an Invoice (dated this year) for the Total Fees Levied by the Secondary Boarding School/Hostel
Invoice Attached:
Yes
SECTION 3: SECONDARY BOARDING SCHOOL DETAILS
Secondary School:
Telephone:
Email Address:
Page 2 of 8 Omataroa Rangitaiki 2 Trust
SECTION 4: SECONDARY SCHOOL ENROLMENT CONFIRMATION
Note: You must get the Principal to verify that the Applicant is currently enrolled and attending the Secondary
Boarding School
I
____________________________________________________________________________Principal
(Principal of the School)
OF ____________________________________________________________________________________
(Name of School)
Certify that ______________________________________________________________________________
(Applicants Name)
Is currently enrolled as a Year ________ full time student and attending classes.
Signature (Principal) _______________________________
Date
_______________________________
This must be stamped by the Secondary
Boarding School.
Official School Stamp
SECTION 5: BOARDING HOSTEL CONFIRMATION
Note: You must get the Hostel Manager (or appropriate personnel) to verify that the Applicant is currently boarding at
the Secondary Boarding Hostel.
I
____________________________________________________________________________________
Offical School Stamp
(Hostel Manager)
OF ____________________________________________________________________________________
(Name of Boarding Hostel)
Certify that ______________________________________________________________________________
(Applicants Name)
Is a full time boarding student.
Signature (Manager) _______________________________
Date
_______________________________
This must be stamped by the
Secondary Boarding Hostel
Official Hostel Stamp
Page 3 of 8 Omataroa Rangitaiki 2 Trust
Offical School Stamp
SECTION 6: BANK ACCOUNT DETAILS
Grants will only be paid by DIRECT CREDIT to a Recognised Secondary Boarding School/Hostel
Bank Account Name:
(Name of Boarding School/Hostel)
BANK ACCOUNT NUMBER:
Bank
Branch
Account Number
Suffix
A verified bank deposit advice must be attached to confirm the above Bank Account Name and Number
SECTION 7: PERSONAL STATEMENTS
1. Commitments by members of your Whanau to assist you in your academic studies:
2. Your own contributions, past, present or future towards the general well-being your Whanau, Hapu and
Iwi:
3. What are your future plans:
Page 4 of 8 Omataroa Rangitaiki 2 Trust
SECTION 8: WHAKAPAPA DETAILS
1. Applicant must be a Shareholder or a Direct Descendant of a Shareholder
2. The name of the Shareholder must correspond with the name of a Current Owner in Trust.
Please refer to the Maori Land Court Website @ www.maorilandonline
3. Current Shareholder must have completed an OMR2 Registration Form.
Please contact the office if you are unsure.
4. Whakapapa must be verified by a Kaumatua however if shareholder is a Whanau Trust, a Trustees of your Whanau
Trust must verify the whakapapa of applicant.
Current Shareholder Name: (Individual)
(if applicable)
Current Shareholder Name: (Trust)
(if applicable)
OMR2 Shareholder Registration No:
(must contact the office if unknown)
Please complete your whakapapa in the section below:
Your Father’s Side:
Father’s Name
Your Mother’s Side:
Mother’s Name
Grandfather’s Name
Grandfather’s Name
Grandmother’s Name
Grandmother’s Name
Great Grandfather’s Name
Great Grandfather’s Name
Great Grandmother’s Name
Great Grandmother’s Name
KAUMATUA/TRUSTEE VERIFICATION:
I ............................................................................... do hereby confirm that the above Whakapapa details
are true and correct.
Signed: ---------------------------------------------------------Page 5 of 8 Omataroa Rangitaiki 2 Trust
SECTION 9: DECLARATION
I hereby certify that the information in this application form is correct, and that my application may be cancelled
(without right of review) if the information supplied is incomplete, inaccurate or not supplied by due date.
I consent to any of this information being made available to Omataroa Rangitaiki No 2 Trust for statistical purposes,
and for my name to be published as a Boarding Grant Recipeint within the Annual Report of Omataroa Rangitaiki No
2 Trust.
I consent to the Boarding School and Hostel with which my child is enrolled releasing any information required
concerning my application form to Omataroa Rangitaiki No 2 Trust in accordance with the Privacy Act 1993 and the
Education Act 1989.
I consent to Omataroa Rangitaiki No 2 Trust contacting any Agencies to verify that information provided in this
application is true and correct, in accordance with the Privacy Act 1993.
Signature (Parent/Guardian)
Date
Page 6 of 8 Omataroa Rangitaiki 2 Trust
IMPORTANT INFORMATION:
1.
2.
3.
4.
5.
The grant is to assist with accommodation costs associated with Boarding Schools
The tenure of the grant shall be for one year only
The amount of the grant is dependent on the number of applicants
Incomplete/Late Applications will not be considered
Payment of all successful applications will be paid directly to the Secondary Boarding
Hostel/School in the month of April 2015
CHECKLIST:
Please ensure you have attached and completed the following information;
Whakapapa Verification
This must be signed by a Kaumatua or Trustee of your Whanau Trust who can confirm both the identity of
the student and Whakapapa to a Current owner in Omataroa Rangitaiki No 2 Trust. If the student is an
owner, this section must still be signed as it is to verify the student’s identity.
Current Shareholder
Applicant or Parent must ensure the Current Shareholder as stated in Whakapapa Section has completed
an OMR2 Shareholders Registration Form.
Enrolment Details Verified by the Secondary Boarding School (See Section 4 on page 3 of 8)
Boarding Hostel Verification (See Section 5 on page 3 of 8)
Invoice for Total Fees levied by the Boarding School for the 2015 year
Personal Statement Completed
Bank Account Details Verified (See Section 6 on page 4 of 8)
Grants are paid directly to the Secondary Boarding School/Hostel
Declaration signed by Student and Parent/Guardian
Page 7 of 8 Omataroa Rangitaiki 2 Trust
ACKNOWLEDGEMENT RECEIPT
2015 BOARDING SCHOOL GRANT
NAME:
ADDRESS:
OFFICE USE ONLY:
Tena Koe
Thank you for your grant application.
Your Application:
Has met all requirements and is referred to the Grants Committee for final approval
Is incomplete and will not be considered. The reasons are:
 Did not meet Whakapapa requirements
 Current Shareholder has not completed the OMR2 Shareholders Registration Form
 Did not have verification of Enrolment
 Did not have an invoice for total fees levied by the Boarding School for the 2015 year
 Did not receive verification from the Boarding Hostel
 Did not complete personal statement
 Did not verify bank account details
 Did not sign declaration
Application was received after due date, and will not be considered
Page 8 of 8 Omataroa Rangitaiki 2 Trust