Parsons Family Fund
And Advance Ashburton Community Foundation
Parsons Family Scholarship
Application Form
Advance Ashburton
PO Box 310
Ashburton
Ph 027 6048013
Email secretary@advanceashburton.co.nz
Enquiries always welcome
Version August 2015
Section 1: APPLICANT DETAILS
Full Name
Title Miss,Ms,Mrs,Mr
Preferred Name
Date of Birth
Address
Contact Telephone
Mobile
Email
Occupation or Training
Residency
Do you or your parents/parent reside between the Selwyn and
Rangitata Rivers
Yes / No
For how many years
……………
Are you a New Zealand Citizen or do you have permanent
New Zealand residency status?
Yes / No
Section 2: EDUCATION SUMMARY
Education
Summary
School /
Institution
Course details, certificates and qualifications
achieved
Tertiary
Secondary
Other
List any leadership and representative roles during past five years:
Started
Finished
I have been accepted / attending (Name of tertiary institution)
To study for
Number of years of study planned
Date when course of study begins
I have applied for / received the following bursaries, awards, grants in the last two years:
What fees are required for your course and how do you intend paying these?
Section 3: PERSONAL ACTIVITIES & COMMUNITY INVOLVEMENT
List any interest/hobbies/sport and community service you currently have or have had:
Section 4: GOALS / ASPIRATIONS
Where do you see yourself on completion of your course?
What are your long term goals and ambitions in your career?
What would receiving this scholarship mean to you
Other Comments
Section 5: REFEREE DETAILS
Name
Address
Phone
Relationship to
Applicant
Name
Years Known
Address
Phone
Relationship to
Applicant
Years Known
Section 6: GENERAL INFORMATION
How did you find out about the Scholarship?
Ashburton Guardian ⃝
Friends/Family ⃝
Poster ⃝
Employer
⃝
Internet
⃝
(Please specify website) ……………………………………………………………………………………….………
Other
⃝
(Please specify) ………………………………………………………………………………………………………..…..
Section 7: DECLARATION AND PRIVACY ACT 1993 AUTHORISATION
This authorization relates to information in this application that Advance Ashburton Community Foundation
(“Advance Ashburton”) may hold about me now or in the future.
 If successful I agree to advise Advance Ashburton if I withdraw from training/study or if in any other
way I have breached the conditions of the scholarship.
 I understand that if I withdraw from training/study before the end of the year that I may be obliged
to refund all or part of the scholarship as determined by the Foundation.
 I will send a copy of my examination results (if applicable) to the Foundation as soon as I receive
them.
 I give permission to Advance Ashburton to make independent confidential inquires relating to my
application.
 If successful I authorise Advance Ashburton to use my name/photograph for publicity purposes and
also to participate in promotional work as may be reasonably required by Advance Ashburton, free
of charge.
 If successful I agree to act as a role model at all times and not to bring Advance Ashburton into
disrepute.
 I accept that the decision of Advance Ashburton is final and no correspondence or communication
will be entered into.
 I declare that the information contained is true and factual.
Full Name of Applicant
Signature
Date
CONDITONS / GUIDLINES
AL INFORMATION
Background
Parsons Family established a Special Named Fund with Advance Ashburton Community Foundation in
2014 to provide a scholarship to eligible person to advance their education, knowledge and experience in
things agricultural, horticultural or aquacultural, whether by way of tertiary education, vocational training
or otherwise.
Eligibility
Applicants shall
 Must reside or have parents who reside between the Selwyn and Rangitata Rivers
 Have permanent resident status
 Must be able to show a satisfactory level of commitment to their chosen vocation
Application Closing Date
Applications are considered once a year. For closing date and more details visit
www.advacneashburton.co.nz
Value and Payment of Scholarship
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The value of the scholarship will be determined each year by the AACF Grants Committee. It may
differ from year to year and may also differ as between applicants.
The scholarship may be used towards living and incidental expenses.
Recipients of the scholarship are not excluded from applying again for a scholarship, however,
preference may be given to first time applicants.
The scholarship may be paid to the university or place of learning, to the parent or guardian of the
recipient or to the recipient at the discretion of Advance Ashburton Community Foundation.
Other Information
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An interview will be required before the AACF Grants Committee.
A scholarship may be revoked if a recipient’s behavior is inappropriate or the recipient has breached
conditions of the scholarship.
Recipient will send to Advance Ashburton Community Foundation their examination results from
the university or place of learning immediately upon receipt.
Recipients may be asked by the Foundation to participate in promotional activities as agreed by
both parties.
What We Are About
Advance Ashburton Community Foundation has been formed as a perpetual charitable trust dedicated to
benefiting the Ashburton District. It is registered as a charity under the Charities Act with number of
CC28482. Donated funds are invested and the Foundation distributes the income to worthwhile
organisations and causes.