DiscoveryCamp (Maori/Pasifika) Application Form
Event Timing: 15 - 20 January 2017
Event Address (2 options): Massey University, Palmerston North or University of Canterbury, Christchurch
Contact us at: MacDiarmid-Institute@vuw.ac.nz 04 463 5950
Surname
Your answer
First Name/s
Your answer
Preferred Name
Your answer
Postal Address
Your answer
Your email Address
Your answer
Main Contact Number
Your answer
Alternative Contact Number (Optional)
Your answer
Parent/Guardian: Name
Your answer
Parent/Guardian: Contact Details (Phone & email)
Your answer
Gender
Ethnicity
(If NZ Maori, please list your Iwi. You may list more than one.)
Your answer
Current Age
Your answer
Current School Year
Your School: Name & Address
Your answer
Name of Teacher Providing Letter of Reference
Your answer
Contact Details for Reference Teacher (Phone & email)
Your answer
NCEA Record of Learning Attached (Required)
Required
Awards/Scholarships/Prizes - Formal Details Attached (If Applicable)
Please tell us why you are applying, and what you hope to achieve by being part of the DiscoveryCamp programme
Your answer
Preferred Location (programme running simultaneously at 2 separate locations)
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