ADVANCED LEARNING SCHOLARSHIP. Including the. JOHN and BETTY ROSE SCHOLARSHIP APPLICATION. All applications to be posted to:

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1 ADVANCED LEARNING SCHOLARSHIP Including the JOHN and BETTY ROSE SCHOLARSHIP APPLICATION All applications to be posted to: The Secretary New Zealand Federation for Deaf Children Inc Johnsonville Wellington 6440

2 Guidelines and Information Background The Advanced Learning Scholarship is a Grant to post secondary students who are attending a recognised New Zealand tertiary institution. Each year the Federation grants up to two Scholarships. Area Covered This is a national scholarship; students may come from any part of New Zealand and may attend any recognised tertiary institution in New Zealand. Applicants must be New Zealand residents. Eligibility The applicant must be Deaf or Hearing Impaired. Proof of hearing loss must be included with this application. Proof of hearing loss may be a copy of an audiogram, a letter from an Audiologist, or Doctor confirming permanent hearing loss The applicant must provide proof of registration to a recognised New Zealand tertiary institution. The applicant must include contact details of two referees A photo of the applicant is to be attached to the application. The applicant or his/her parents must be financial members of a Parent group or may apply to become an associate member of Federation in accordance with our constitution. Recipient s Responsibilities The recipient will provide the Federation with a minimum of two progress reports during the scholarship year. The Final report will include an official end of year report showing the applicants results. The recipient will provide a copy of an official end of year report showing their examination results. The recipient will provide a report showing how the scholarship was used. (Failure to provide these reports will work against the recipient receiving any further support from the New Zealand Federation for Deaf Children Inc.) Payment The Federation Executive Committee will select the scholarship winners, forwarding their confirmation letter/s and award within 30 days of the award decision/s.

3 Sections marked * are compulsory Section 1: Applicant s Details Full Name: *... Date of Birth: *...Gender: Male / Female Ethnicity: *...Iwi affiliation (if applicable):... Postal Address: * Post Code: *... Telephone: *(... )...Mobile:... Section 2: Parent Group Affiliation Name of Parent Group you or your parents are affiliated with: *... If your parents are members please provide their details: Name of Parents / Guardians:... Parents Postal Address: Post Code:... Parents Telephone: (... )... Mobile:... Parents Address:... Section 3: Course Details Name of Course: Name of Course Provider:... Part Time / Full Time (circle one) Current Educational Qualifications and Experience: (Continue on separate page if more space is required) What Educational Supports do you expect to need? Note takers, Interpreters, Other:... Proposed Occupation:...

4 Section 4: Funding Details How do you plan to use this scholarship? Please provide details of all other scholarships and grants you have applied for or have been awarded, for this educational year: Section 5: Referee s Details Name of Referee 1:... Postal Address: Postal Code:... Telephone: (...)... Mobile:... Name of Referee 2:... Postal Address: Postal Code:... Telephone: (...)... Mobile:...

5 Applicants Check List: All 5 sections of this application have been filled out completely. Proof of hearing loss is included. Proof of registration of tertiary institution is included. Proof of residency (if applicable) is included. Photo attached Declaration - I am a New Zealand citizen or have permanent residence status. - I authorise the NZ Federation for Deaf Children Inc to use this information for the purpose of administration and consideration of this application. - I authorise the NZ Federation for Deaf Children Inc to make any enquiries of any third parties in connection with this application. - If successful, I authorise the NZ Federation for Deaf Children Inc to use my name/photograph for publicity purposes. - If successful, I agree to provide the NZ Federation for Deaf Children Inc with progress reports, examination results and an expenditure report showing how this scholarship was used. - I accept that the decision of the NZ Federation for Deaf Children Inc is final and no correspondence will be entered into. - I declare that the information contained in this application is true and factual. Signature:... Date:... For office use only: Action Verification Date All 5 sections of this applications have been filled out completely Proof of hearing loss included Proof of residence (if applicable) is included Receipt of Application acknowledgement letter sent Referee 1 contacted Referee 2 contacted Parent Group Affiliation confirmed Meeting to be presented to committee Application unsuccessful Applicant advised Applicant successful Applicant advised, include cheque, receipt letter and certificate Rose Family advised with copy of application Progress report 1 received Progress report 2 received Progress reports sent to the Rose Family Scholarship expenditure report received