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ENTRY FORM - NORTH HARBOUR CLUB AIMES AWARDS 2011

Please complete all sections of the application form below, there are opportunities for you to upload information and supporting documentation which you are encouraged to do within the specified size limits.

Once submitted, you will receive an email receipt of your application, if for some reason you do not receive this please contact Catherine Lidgard at catherine@northharbourclub.co.nz to ensure your application has been received.

The North Harbour Club cannot be held responsible for any applications that are not received.

Please note:

The closing date for AIMES applications in 2011 is 15th July 2011 at 5pm

To be eligible to apply for a North Harbour Club AIMES Award, applicants must:-

  • Be aged between 13-25 years as at Friday 15th July 2011.
  • Have lived in the North Harbour region and/or can demonstrate a strong affiliation with the North Harbour region for a period of not less than 2 calendar years.
  • Be able to demonstrate the achievement of excellence in their chosen field.
  • Be able to complete all sections and meet the expectations of the application form in full as requested.

(Eligibility will be decided by the Judging Panel and no correspondence will be entered into)

Fields marked with * are compulsory

1. Name:
First Name: * Middle Name: Family Name: *
2. New Zealand Postal Address:
*
3. Permanent Residential Address: Same as postal address?
*
4. Telephone/E-Mail Contact Details
Day: *After Hours:*N.Z. Contact No.:
Mobile: Email:*

Please note: If travellinig overseas, internet access may be required for telephone interviewing if shortlisted.

5. Place and Country of Birth:
* * Please upload copy of evidence: * (Please provide in JPG, PNG, GIF formats)
6. Date of Birth: Please attach copy of your Birth Certificate
* Upload Birth Certificate: * (Please provide in JPG, PNG, GIF formats)
7. Category Entered:
* (Speciality)

Please note: the Judging Panel reserve the right to transfer applications between categories should they deem it appropriate.

8. Education Achievements: (Please include all schooling, i.e. Primary, Intermediate, Secondary/College & Tertiary)
InstitutionPlace & CountryFrom (year)To (year)Achievements

Click here if you need more fields!
9. Referees:

Please give the names, addresses and contact details of two referees who are williing and able to verify your claims and comment on your suitability for this Award. Applicants must ensure that the referees are advised of their nomination and the purpose. The Judging Panel reserves the right to extend its reference base to people and organisations beyond those nominated by you.

Referee 1Referee 2
Name:*Name:*
Address:*Address:*
Email:Email:
Phone: (home)*
(Business)*
(Mobile)		 Phone: (home)*
(Business)*
(Mobile)
Occupation:*Occupation:*
Relationship to the applicant:*Relationship to the applicant:*
10. Present Your Case for the Award:     Note: This section is the key to your application.

On a separate sheet which can be uploaded below, please detail why you believe you qualify for an AIMES award.

Please include your achievements to-date in your chosen category and any other relevant achievements. Please also include your future aspirations, intended development programmes (including indicative costs and timing) and how you would spend any funds awarded.

Upload file: * (Maximum file size 1MB, please provide in RTF,TXT, DOC, PDF formats)
11. Other Major Awards Recieved, Relevant to your Application:

Have you received any awards from other bodies that are relevant to your application? If so, please give details:
12. Additional Information:

Applicants may enclose additional material such as photographs, videos, CD/DVDs, copies of reports, write-ups, endorsements or references relevant to their nominated category.
Applications and any attachments/inclusions cannot be returned, therefore please provide copies of information only.

The North Harbour Club
Attn: The Judging Panel
PO Box 31599
Milford
North Shore City
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