SA25 Young Contributor Award Application Form

SA25 Young Contributor Award Application Form

PLEASE NOTE: This application form cannot be saved part way through for completion at a later time. Please ensure you have all required relevant information and documentation ready prior to commencement. Applications close 31 May 2025.

First Name*

Last Name*

Postal Address*

Contact Number*

Email Address*

Date of Birth*

Parent/Guardian Name

Please provide the name of your parent/guardian if you are under 16 years of age.

Parent/Guardian Contact Details

Please provide the contact details of your parent/guardian if you are under 16 years of age.

Q1*

Please outline/describe your achievement or contribution to the community and why you would like to be considered for this award. (max 250 words).

Q2*

Please explain how your leadership and leadership qualities provide a benefit to the Waikirikiri Selwyn district (max 250 words).

Q3*

Please provide your vision or goals for the future and how this will contribute to Waikirikiri Selwyn in the long term (max 250 words).

Q4*

Please explain your dedication and why your work is important to you (max 250 words).

Q5*

Please provide evidence of any persistence you have shown through your area of success (max 250 words).

Q6*

Explain how you are contributing to leaving lasting and positive impacts on the Waikirikiri Selwyn district (max 250 words).

File Upload*

Please upload the following; Business logo, if applicable, in full colour and white only on transparent background (.png or .eps file) Photo – 1 x high resolution hero shot and evidential images relevant to your business – max 4 additional images.

Drag and drop files here or

Marketing Privacy*

Applicants acknowledge and agree that by submitting an application, any personal information provided will be collected, used, and stored in accordance with the New Zealand Privacy Act 2020.

Eligibility and Conditions of Entry*

As the applicant’s information and images can be used for promotional purposes, please tick to acknowledge this application is being submitted by the applicant organisation or individual named above and you have read and accept the “Eligibility and Conditions of Entry”

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