Aspire Scholarship 2016

Private Secondary Schools Scholarship Application form

Completed application forms must be returned to the Ministry of Education by 5pm on Friday, 24 April 2015.

The Aspire Scholarship is for students who would like to attend a New Zealand private secondary school and are part of a family with a low household income and net worth (asset minus liabilities). The scholarship contributes up to $15,000 per year for private secondary school tuition fees and up to $1,500 per year for course related costs. Please note it is the responsibility of the parents/caregivers to pay for any remaining school fees over and above the contribution from the Aspire Fund.

To apply for the scholarship, please answer all questions in this application form, provide all required supporting documents, and post to the Ministry of Education National Office by 5pm on Friday, 24 April 2015 (must be received at the Ministry by this time).

Please read all information on this page before proceeding with the application, and refer to the Application Guidelines for additional help with the questions.

A student is eligible for an Aspire Scholarship if:

 they will be in year 9 in 2016

 their primary caregiver(s) have a combined annual gross income of $56,000 or less (not including Working For Families tax credits)  their primary caregiver(s) have a combined net worth of $200,000 or less (not including household items e.g kitchen appliances and furniture)

 they, or their primary caregiver(s), are not beneficiaries of any trusts (exceptions will be considered on a case by case basis)

 they are a New Zealand citizen or a permanent resident of New Zealand.

Before you apply for an Aspire Scholarship, please be aware that it:

 may not cover all fees and costs at some private schools

 can only be used at the private schools listed on the following pages

 cannot be used at any state or state-integrated schools

 cannot cover boarding fees.

 Cannot be used before 2016 for application or enrolment fees at a private school in 2015

Aspire Scholarship 2016 | Application form Page 1 of 19 Private schools compatible with the Aspire Scholarship Programme1 Northland

Otamatea Christian School email: [email protected] telephone: 09 431 8487 Springbank School email: [email protected] website: http://www.springbank.school.nz telephone: 09 407 5236 Huanui College email: [email protected] telephone: 09 4591930 North Shore

City Impact Church School email: [email protected] website: http://www.cityimpactchurch.school.nz telephone: 09 477 0302 email: [email protected] website: http://www.kristin.school.nz telephone: 09 415 9566 Living Way Learning Centre email: [email protected] telephone: 09 423 7727 email: [email protected] website: http://www.pinehurst.school.nz telephone: 09 414 0960 The Corelli School email: [email protected] website: http://www.corelli.school.nz telephone: 09 476 5043 Wentworth College email: [email protected] website: http://www.wentworthcollege.school.nz telephone: 09 424 3273 Auckland

ACG Parnell College email: [email protected] website: http://www.acgedu.com telephone: 09 308 1666 ACG Senior College email: [email protected] website: http://www.acgedu.com/nz/senior telephone: 09 307 4477 ACG New Zealand International College email: [email protected] website: http://www.acg.ac.nz telephone: 09 307 4471 Auckland International College email: [email protected] website: http://www.aic.ac.nz telephone: 09 3094480 Carey College email: [email protected] website: http://www.careycollege.com telephone: 09 570 5873 Destiny School email: [email protected] website: http://www.destinyschool.org/ telephone: 09 527 7312 email: [email protected] Diocesan School For Girls website: http://www.diocesan.school.nz telephone: 09 520 9225 Hebron Christian College (Auckland) email: [email protected] website: http://www.hebron.ac.nz telephone: 09 846 2159

1 All private, fully registered schools that accept students in years 9 – 13 (including secondary schools and some composite schools) are able to accept the Aspire Scholarship except Dilworth School, Nga Kakano Christian Reo Rua Kura and Odyssey House School. Dilworth School and Nga Kakano Christian Reo Rua Kura is not compatible with the Aspire programme because it does not charge tuition fees and Odyssey House School is not compatible because enrolment is only possible on the basis of referral.

Aspire Scholarship 2016 | Application form Page 2 of 19 Kings College email: [email protected] website: http://www.kingscollege.school.nz telephone: 09 276 0600 MindAlive email: [email protected] website: http://www.mindalive.co.nz telephone: 093093300 Mt Hobson Middle School email: [email protected] website: http://www.mthobson.school.nz telephone: 09 523 1241 St Cuthberts College (Epsom) email: [email protected] website: http://www.stcuthberts.school.nz telephone: 09 520 4159 The Bridge Academy email: [email protected] website: http://www.thebridgeacademy.co.nz telephone: 09 535 0574 Waitakere

ACG Sunderland College email: [email protected] website: http://www.acgedu.com/ telephone: 09 838 7070 Immanuel Christian School email: [email protected] website: http://www.immanuel.school.nz telephone: 09 828 4545 Nga Kakano Christian Reo Rua Kura email: [email protected] telephone: 09 835 3626 Manukau

ACG Strathallan email: [email protected] website: http://www.acgedu.com telephone: 09 295 0830 Ambury Park Centre for Riding Therapy email: [email protected] website: http://www.amburyparkcentre.org.nz/ telephone: 09 634 0763 Drury Christian School email: [email protected] telephone: 09 294 7332 Pukekohe Christian School email: [email protected] website: http://www.pcschool.co.nz telephone: 09 238 6449 St Kentigern College (Pakuranga) email: [email protected] website: http://www.saintkentigern.com telephone: 09 577 0749 Tyndale Park Christian School email: [email protected] website: http://www.tyndalepark.school.nz telephone: 09 274 9771 Westmount School email: [email protected] telephone: 09 636 1255

Aspire Scholarship 2016 | Application form Page 3 of 19 Waikato

Cambridge International College email: [email protected] website: http://cic.school.nz telephone: 07 8392010 Hamilton Christian School email: [email protected] website: http://www.hamiltonchristian.school.nz telephone: 07 854 0010 St Paul’s Collegiate (Hamilton) email: [email protected] website: http://www.stpauls.school.nz/ telephone: 07 957 8899 St Peter’s School (Cambridge) email: [email protected] website: http://www.stpeters.school.nz telephone: 07 827 9899 Bay of Plenty

Rangitaiki email: [email protected] website: http://www.rangitaiki-ind.school.nz telephone: 07 308 9903 Whanganui

St Dominics College email: [email protected] telephone: 06 344 3814 Hawke’s Bay

Hohepa Home School (Napier) email: [email protected] telephone: 06 844 2740

Wellington

Chilton St James School email: [email protected] website: http://www.chilton.school.nz telephone: 04 566 4089 Hutt Valley Christian School email:[email protected] website:http://www.wellingtonchristianschools.org.nz telephone: 04 564 8552 Queen Margaret College email: [email protected] website: http://www.qmc.school.nz telephone: 04 473 7160 Samuel Marsden Collegiate School email: [email protected] website: http://www.marsden.school.nz telephone: 04 476 8707 Samuel Marsden Collegiate School - email: [email protected] Whitby website: http://www.marsdenwhitby.school.nz telephone: 04 234 1070 Scots College email: [email protected] website: http://www.scotscollege.school.nz telephone: 04 388 0850 West Coast

Gloriavale Christian Community School email: [email protected] telephone: 03 738 0257

Aspire Scholarship 2016 | Application form Page 4 of 19 Christchurch

Christ’s College email: [email protected] website: http://www.christscollege.com telephone: 03 364 6836 Rangi Ruru Girls’ School email: [email protected] website: http://www.rangiruru.school.nz telephone: 03 983 3700 St Andrew’s College (Christchurch) email: [email protected] website: http://www.stac.school.nz telephone: 03 940 2000 St Margaret’s College email: [email protected] website: http://www.stmargarets.school.nz/ telephone: 03 379 2000

Aspire Scholarship 2016 | Application form Page 5 of 19 Privacy statement The personal information in this application is being collected by the Ministry of Education for the purpose of considering your application for an Aspire Scholarship. The information will be used only for the purpose of considering the application, administering the scholarship if the application is successful, and for statistical and research purposes.

The Ministry will share information with others only if this is necessary for carrying out the purposes outlined above.

The identities of all applicants will remain protected by the Ministry, and will not be released to the general public.

The information collected is held by the Education, Curriculum and Performance team, Ministry of Education and you have the right to access and request a correction of this information.

Aspire Scholarship 2016 | Application form Page 6 of 19 Student details

1. Name of 1a. First name(s) student 1b. Last name

1c. Other last name student known by (if applicable)

2. Date of birth 3.Gender (Please circle Female Male or underline)

Day Month Year 4. Ethnicity (Please circle, underline or tick beside the student’s most appropriate ethnicity category)

Chinese Cook Island Māori Fijian Indian

New Zealand Niuean New Zealand Māori Samoan European/Pākehā

South East Asian Other Asian Tokelauan Tongan

Other European Other Pacific Islander Other (please state):

5. Iwi affiliation(s) (Please list if appropriate)

6. Residency (Please circle or underline the student’s residency category and provide verification of this)

New Zealand Permanent resident Other citizen2 of New Zealand3

Have you answered every question on this page? If not, your application may not be accepted.

2 Attach a copy of the student’s birth certificate and passport. You do not need to get this signed by an authorised person. 3 Attach a copy of the student’s birth certificate or passport and permanent resident’s visa..

Aspire Scholarship 2016 | Application form Page 7 of 19 Schooling details

7. Will the student be in year 9 in 2016? Yes No (Please circle or underline) Please note that if you answer no to question 7 the student is not eligible for the 2016 Aspire Scholarship. 8. Which school does the student currently attend?  If the student is not currently attending school, please state the school they most recently attended.  If the student is homeschooled, please indicate.

Have you answered every question on this page? If not, your application may not be accepted.

Aspire Scholarship 2016 | Application form Page 8 of 19 Caregiver details

9. How many primary caregivers does this student have? (Please indicate in the box to the right) Primary caregivers include:

 all step parent(s), guardian(s) and relative(s) who live in the student’s household and act in the place of a parent AND  all step parent(s), guardian(s) and relative(s) who do not live in the student’s household, but share full financial responsibility for the student. Any caregivers who pay child support money for the student, but have no other financial responsibility for the child, do not need to be listed as a primary caregiver.

Details for first primary caregiver (The primary caregiver who will make the statutory declaration) 10. Name 11. Relationship to student

12. Occupation

13. Home 13a. address Street address 13b. suburb 13c. 13d. City Postcode 14. Postal address (If different from above) 15. Phone numbers 15a. Home ( ) - 15b. Work ( ) - 15c. ( ) - Mobile(s) 16. Email address:

Second primary caregiver details (if applicable)

17. Name 18. Relationship to student

19. Occupation

Have you answered every question on this page? If not, your application may not be accepted.

Aspire Scholarship 2016 | Application form Page 9 of 19 Family income Employment 20. Please indicate for each primary caregiver whether they are employed, self employed or unemployed:

20a. First primary caregiver: Employed Self-employed Unemployed

20b. If you circled ‘Self employed’, please provide details of the business in the box provided and attach your 2013/14 financial statements4.

Self- 20c. Second primary caregiver: Employed Unemployed N/A employed

20d. If you circled ‘Self employed’, please provide details of the business (if different from above) and attach your 2013/14 financial statements5.

Self- 20e. Third primary caregiver: Employed Unemployed N/A employed

20f. If you circled ‘Self employed’, please provide details of the business (if different from above) and attach your 2013/14 financial statements6.

2013/14 income (in New Zealand dollars) Please declare the total gross income earned in the 2013/14 financial year (1 April 2013 – 31 March 2014) for each primary caregiver. This does not include Working For Families tax credits. 21. First primary caregiver7: $ 22. Second primary caregiver (if applicable)8: $ 23. Third primary caregiver (if applicable)9: $ TOTAL: $

Have you answered every question on this page? If not, your application may not be accepted.

4 Attach your 2013/14 financial statements for this business. 5 Attach your 2013/14 financial statements for this business. 6 Attach your 2013/14 financial statements for this business. 7 Attach a 2013/14 summary of earnings or notice of assessment from Inland Revenue (IRD), or an income assessment from Work and Income, for this caregiver. 8 Attach a 2013/14 summary of earnings or notice of assessment from Inland Revenue (IRD), or an income assessment from Work and Income, for this caregiver, if applicable. 9 Attach a 2013/14 summary of earnings or notice of assessment from Inland Revenue (IRD), or an income assessment from Work and Income, for this caregiver, if applicable.

Aspire Scholarship 2016 | Application form Page 10 of 19 Reduced or increased household income since 31 March 2013 24. Has your total household income reduced, Reduced Increased Stayed the increased, or stayed approximately the same same since the end of the 2013/14 financial year (31 March 2014)? (Please circle or underline)

24a. If you circled ‘stayed the same’, please move to question 26.

24b. If you circled ‘reduced’, please explain why, in the box to the right.

24c. If you circled ‘increased, please explain why, in the box to the right.

24d. Please indicate what your reduced or increased total household income is now and provide verification of this10.

24e. If you circled ‘reduced’ in question 25, do you anticipate that your household income will return to its original level in the coming year? For example, if you have just left your current employment, do you Yes No intend on working at the same level in the next year? (Please circle or underline) 24f. If you answered question 24e, please explain why. Otherwise, go to question 25.

*Please note that an audit of successful applications may be undertaken in 2016.

Have you answered every question on this page? If not, your application may not be accepted.

10 Attach supporting documents if income has reduced or increased since the end of the 2013/14 financial year for any primary caregivers. Supporting documents could include a letter from an accountant, payslips or a letter from an employer, or an Inland Revenue (IRD) personal tax summary for 2014/15.

Aspire Scholarship 2016 | Application form Page 11 of 19 Additional income 25. Does anyone other than the student’s primary Yes No caregivers provide financial assistance for this student? (Please circle or underline) 25a. If yes, please indicate who by circling or underlining all that apply, below. If no, go to question 26.

Father Grandparents Other Other family/whānau (Please state):

25b. Name

25c. Occupation 25d. Phone

25e. Home Address 25f. City

25g. Please explain: i. the type(s) of financial assistance that is provided, for example, compulsory child support or voluntary payments etc and ii. how much financial assistance the stated person/people provide per week.

i.

------

ii.

26. Was any other additional income received by the student’s Yes No primary caregiver(s) during the 2013/14 financial year other than that already mentioned, above11? 26a. If yes, please list each Source(s) of Income: Total source of income, and the income total amount received during amount(s) the 2013/14 financial year.

$

$

$

Have you answered every question on this page? If not, your application may not be accepted.

11 Attach documentation to verify additional income, if applicable. i.e. other scholarships, stipends, grants awarded to a caregiver or student.

Aspire Scholarship 2016 | Application form Page 12 of 19 Family net worth (In New Zealand dollars)

27. Do you own any property? (Please circle or underline) Yes No Please note that if you share ownership of a property, the full value of the property must still be declared (in question 29) unless you have legal verification that shows proportionate ownership.

27a. If no, please move to question 28. If yes, please indicate how many

properties you own in the box to the right.

27b. Please explain what

each property is used for.

28. Do you rent the property you live in?12 Yes No (Please circle or underline)

28a. If you don’t own or rent the property you live in please explain your living circumstances.

29. Please add the dollar value of all specified assets and debt that you have, in the table below. Please fill in every box and write ‘0’ (zero) if the value is 0 (nothing). Please also note that you may only include store card and credit card debt that was current between 4 November 2014 and 9 January 2015. For example, if you have used your credit card for expenses after 9 January 2015, you cannot add this debt to the table.

Assets Value Liabilities Balance 29a. Cash (including term $ 29f. Total amount owing on any $ deposits and funds held in mortgage(s)13 savings accounts) 29b. Total value of all property $ 29g. Total amount owing on cars, $ owned as verified by a Quotable boats, and/or any recreational Value (QV) rating or a Council vehicles15 Rating Value (RV)14 29c. Total market value of any $ 29h. Total amount owing on $ business interests student loans16 29d. Total resale value of $ 29i. Amount owing on credit $ vehicles, boats and/or other card(s)17 recreational vehicles 29e. Total value of investments $ 29j. Amount owing on store $ card(s)18 TOTAL ASSETS $ TOTAL LIABILITIES $

You must provide verification of:

12 If yes, attach a copy of your tenancy agreement or a letter from your landlord confirming your tenancy. 13 Attach mortgage statements for any property, dated no earlier than November 2013. 14 Attach a current Quotable Value (QV) rating or a Council Rating Value (RV) for any property owned. 15 Attach relevant verification. 16 Attach relevant verification. 17 Attach relevant verification, dated between 4 November 2014 and 9 January 2015. 18 Attach relevant verification dated between 4 November 2014 and 9 January 2015.

Aspire Scholarship 2016 | Application form Page 13 of 19  all property (QV/RV statements)  all mortgages  all debt However, you do not need to provide verification for assets other than property – you must just describe them, below. 30. Please describe any other assets that you declared in questions 29a, 29c, 29d, 29e for example, if you declared a car in question 30d, provide the make of the car etc.

30a. Type of asset:

30b. Description: (e.g. what the item is, the make of the item etc.)

30c. Type of asset:

30d. Description: (e.g. what the item is, the make of the item etc.)

30e. Type of asset:

30f. Description: (e.g. what the item is, the make of the item etc.)

30g. Type of asset:

30h. Description: (e.g. what the item is, the make of the item etc.)

30i. Type of asset:

30j. Description: (e.g. what the item is, the make of the item etc.)

Have you answered every question on this page? If not, your application may not be accepted.

Aspire Scholarship 2016 | Application form Page 14 of 19 Trusts If the student and/or their caregivers are beneficiaries of any trusts, the student is not eligible for the Aspire Scholarship. However, this criterion can be waived if the applicant makes an acceptable case for doing so. For example, if a student is a beneficiary of a trust but will never receive more than $100 for school books per year from the trust, the criterion can be waived. But, for example, if the student and/or caregiver is a beneficiary of a family trust, and there is a property in the trust with a current net worth value exceeding the $200,000 net worth eligibility threshold, the criterion would not be waived.

31. Is the student and/or any of the student’s primary caregivers beneficiaries of any trusts? (Please circle or underline) Yes No

If no, please move to question 32. If yes, please describe (below):

31a. how many trusts

31b. what type of trust(s) 19 these are

31c. the total value of any assets in the trust(s)20

31d. the total income received from the trust during the 2013/14 financial year21.

Have you answered every question on this page? If not, your application may not be accepted.

19 Attach all relevant documentation about these trust(s). 20 Attach a Quotable Value (QV) rating or a Council Rating Value (RV) if these asset(s) are property. 21 Attach relevant statements verifying this income.

Aspire Scholarship 2016 | Application form Page 15 of 19 Referees Please provide contact details for two referees. The first one may be a selected referee, such as a non-related friend or church member. The second one must be a recent teacher (or another selected referee, if the student is currently homeschooled). The Ministry of Education may make contact with these individuals to verify any details provided in the application.

First referee contact details (Any non-related person known to you) 32. Name of referee:

33. Relationship to student:

34. Address:

35. Phone numbers: 35a. Home ( ) -

35b. Work

35c. Mobile(s) 36. Email address

Second referee contact details (A recent teacher, or another selected non-related person known to you if student is currently homeschooled) 37. Name of referee:

38. Relationship to student:

39. Address:

40. Phone numbers: 40a. Home ( ) -

40b. Work

40c. Mobile(s) 41. Email address:

Have you answered every question on this page? If not, your application may not be accepted.

Aspire Scholarship 2016 | Application form Page 16 of 19 Statutory declaration (Must be handwritten)

This statutory declaration must be witnessed by a solicitor, a Justice of the Peace, a Court Registrar, or other person authorised to take a statutory declaration.

I,

(full name of primary caregiver) of,

(home address) solemnly and sincerely declare that the information I have provided in this application is true and correct.

I make this declaration conscientiously believing the same to be true and by virtue of the Oaths and Declarations Act 1957.

Signature

Declared at

(town/city/district)

Date

Official witness name, in full

Signature of witness

Occupation of witness

Address of witness

There are penalties under the Crimes Act for providing false information and provision of false information will also result in the termination of the scholarship.

The Ministry may audit applications at random, or if there is any reason to suggest information in an application is inaccurate.

Aspire Scholarship 2016 | Application form Page 17 of 19 Checklist

Tick () Completed application forms must include the following: or mark ‘NA’ (Not Applicable) 1. A copy of the student’s birth certificate or passport and residential visa.

2. 2013/14 financial statements for any businesses that the student’s primary caregivers have a financial interest in, if applicable.

3. One of the following for every primary caregiver: (including caregivers who did not earn anything) a. a 2013/14 summary of earnings from Inland Revenue (IRD) b. a notice of assessment from Inland Revenue (IRD) c. an income assessment from Work and income.

4. Supporting documents if income has reduced or increased since the end of the 2013/14 financial year (31 March 2014) for any primary caregivers, if applicable.

5. Documentation to verify any additional income received in the household(s) that the student lives in (not including Working For Families tax credits), if applicable.

6. A copy of your tenancy agreement or a letter from your landlord, if you rent a property.

7. Mortgage statements dated no earlier than November 2014 for any mortgages held.

8. A current Quotable Value (QV) rating or a Council Rating Value (RV) for any/all property owned.

9. Documentation to verify all other debt/liabilities declared.

10. A Quotable Value (QV) rating or a Council Rating Value (RV) for any property owned by any associated trusts, if applicable.

11. Relevant statements verifying any income received from any associated trusts during the 2013/14 financial year.

12. Any other relevant documentation about any associated trust(s), if applicable. 13. A statutory declaration signed by a primary caregiver, in front of a person

who is authorised to witness a statutory declaration (such as a justice of the peace, a solicitor or a court registrar).

Aspire Scholarship 2016 | Application form Page 18 of 19 Where to send completed applications Completed applications must be received at the Ministry of Education National Office by: 5pm on Friday, 24 April 2015.

Ministry of Education National Office Ministry of Education National Office Postal Address: Physical Address:

Aspire Ministry of Education Ministry of Education Level 3 / 45 – 47 Pipitea Street PO Box 1666 St Paul’s Square Wellington 6140 Thorndon Wellington 6011

Applications will only be accepted by post. Applications will not be accepted if they are emailed or faxed.

Applications received after 5pm on Friday, 24 April 2015 will not be accepted, even if they have been posted before this date. You can courier or hand-deliver your application if necessary.

Aspire Scholarship 2016 | Application form Page 19 of 19