Prime Minister S Pacific Youth Awards Application Form 2018

Prime Minister S Pacific Youth Awards Application Form 2018

Prime Minister’s Pacific Youth Awards Application Form 2018

How your information will be used
I understand that:

  1. The Ministry for Pacific Peoples (The Ministry) is collecting the personal informationsupplied by me on this form for the purposes of the Prime Minister's Pacific Youth Awards.
  2. My personal information is provided to the Ministry for the purposes of processing my application.
  3. The information supplied by me on this form may be shared with the Sponsor of any Award I apply for, to enable the consideration and assessment of my application.
  4. The Ministry will seek my prior authorisation before using my personal information for Awards promotional purposes.
  5. The information supplied by me on this form will be collected and held by the Ministry. The address of the Ministry is: Ministry for Pacific People’s 101-103 The Terrace, P O Box 833 Wellington. The Ministry can be contacted by email at
  6. My personal information is being provided voluntarily. If all the information requested is not provided, there are no consequences except where it may affect eligibility for entering the Awards. I am entitled to have access to and request correction of any of my personal information held by The Ministry.

Tell us about yourself

Name
Address
Date of birth / Gender / M ☐ / F☐
Phone Details / Home / Mobile
Email 1 / Email 2:
Tick all that apply to you
Which ethnic group(s) do you belong to? / Which country were you born in?
Cook Island Maori / ☐ / Cook Island / ☐ /
Fijian / ☐ / Fiji / ☐ /
Maori / ☐ / New Zealand / ☐ /
New Zealand European / ☐ / Niue / ☐ /
Niuean / ☐ / Samoa / ☐ /
Samoan / ☐ / Tokelau / ☐ /
Tokelauan / ☒ / Tonga / ☐ /
Tongan / ☐ / Other (please specify)
Other Pacific Peoples (please specify)
If you were not born in New Zealand, what year did you arrive?
If you were not born in New Zealand, please indicate if you are: / New Zealand Citizen / ☐ /
Permanent Resident / ☐ /
Neither / ☐ /
Have you had a criminal conviction in the last five years? / Yes ☐ / No ☐
If you answered ‘yes’, please describe what was the conviction?
How did you hear about the awards?
☐Friend / ☐Poster
☐Relative / ☐Postcard
☐Teacher / ☐Church
☐School / ☐Facebook
☐MPP stff member / ☐Radio (please specify)
☐News story / ☐Website (please specify)
☐Poster / ☐Other (please specify)

Which award are you applying for?

☐Air NZ Leadership & Inspiration Award supported by Ministry of Foreign Affairs and Trade
☐New Zealand Institute of Sport - Sports & Fitness Award
☐Auckland Council - Community Star Award
☐AkoAotearoa- STEM (Science, Technology, Engineering & Mathematics) Award
☐BNZ Commercial & Corporate Awardsupported by Ministry for Pacific Peoples -
☐Creative NZ and Massey University- Arts & Creativity Award
☐Deloitte - Business & Enterprise Award
☐Pacific Cooperation Foundation - International Scholar Award

Criteria Eligibility: Why do you think you deserve this Award?

Describe how you meet each criteria for your category
Provide 2 examples of what you have achieved under the category you are applying for

Describe any challenges or obstacles you have overcome to achieve what you have.

In 150- 250 words explainyour future goals and aspirations and how the award will assist you in achieving this.

In 150- 250 words outline what involvement you have within the Pacific community or what you might have in the future.

Referees

Please provide at least two written references to illustrate your ability to meet the criteria of the award you are applying for, your potential to advancing positive outcomes in the Pacific community and why you deserve the award.

Please note that your application cannot be considered without the two references.

Top View