Talented School Students Travel Award

Application for Funding Form

PART ONE

Full name:

Address:

School:Year Level:

DOBAge:

Passport Number: Issued: Expiry:

Phone Number Cell:

Email: (please do not provide a school email address)

PART TWO

Please name the event you have been selected for?

Which organisation or national event/competition selected you?

Start Date of event: End Date of event

Location of event :

PART THREE

What is the cost of your travel?

Registration costs?

Has the TSSTA already paid for this upfront already?Yes No Unsure

Travel Insurance costs?

NB: If you have been specifically selected by the Royal Society of New Zealand to attend an event then your travel insurance is covered by the Royal Society Te Apārangi and there is no need to purchase travel insurance. However all other students must purchase travel insurance.

VISA costs:

Accommodation costs?

(please note accommodation will only be supported one day prior and during the event)

TOTAL:

Are you receiving monetary support from other sources? YESNOAmount:

Are you or is your school undertaking any fundraising?YESNO

PART FOUR

Privacy Legislation requires you to give the Royal Society of New Zealand written permission to use your name for publicity purposes in regards to your selection and support of funding by this fund: The Royal Society of New Zealand will produce a media release about your selection to the event and make mention that the TSSTA Fund has supported you to attend. In this case media will need to make contact with you. Do you agree to this?

Signed by student: Signed by parent or guardian:

PART FIVE

Please include the following material with this application form

Copy of passport or birth certificate □ Bank Deposit Slip □Copies of itinerary and proof of costs □

Verified copy of Academic Results□Testimonial letter from HOD Science co-signed by principal □

NB:If the student has beenspecifically selected by Royal Society Te Apārangi to attend an event then we will already have academic and testimonial results. Therefore those students are only required to send a bank deposit slip and proof of costs associated with any travel costs. Other students must send all supporting documents required above.

PART SIX - AGREEMENT

As part of the TSSTA Funding agreement to help support you to travel to an international event you are agreeing to produce a two page report within three weeks of your return to New Zealand. You will receive a reminder about your report on your return. Writing a report is compulsory if you have received TSSTA funding.

Do you agree to write the report? YESNO

Student NameSignature

Guardian Name: Signature

All students who are funded are required to write a two page report based upon their experience of the event they have attended.

Guidelines on writing your two page report.

  • Write your name at the top of the page and the event you attended
  • Attach with your report at least one photo of you at the event that can be used for RSNZ reporting purposes.
  • The report should be a general account of your experience but please also include answers to the following questions.
1.How has attending this event demonstrated greater knowledge of available career paths in science and technology?
  1. How has attending this event enthused or inspired youto pursue science and technology careers?
  2. Has attending this event changed about how you feel about science or technology?
  3. How has attending this event and participating with like-minded students been of benefit to you?
  4. Now that you have had time to reflect about your experience what have you learnt about yourself?
  5. What did you enjoy about your experience?

FOR OFFICE USE ONLY

What percent has the student been funded? Total amount funded

Has the applicant supplied all documents required?

Does the applicant meet the criteria?

Do we need to invoice student? YES NO

If yes, applicant invoiced for:

If not have much is the student to be reimbursed?

1 ROYALSOCIETY.ORG.NZ