SA25 Community Volunteer Award Application Form (Individual)

SA25 Community Volunteer Award Application Form (Individual)

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*

Website URL

Q1*

Please outline/describe your outstanding voluntary contribution to improve the quality of life for people in the Waikirikiri Selwyn district and explain why you would like to be considered for this award. (max 250 words).

Q2*

Please describe how you dedicated your time to community volunteering (max 250 words).

Q3*

Please describe how you are trying to help improve the lives of others in the community (max 250 words).

Q4*

Please explain how your volunteer work contributes to a safe connected Waikirikiri Selwyn (max 250 words).

Q5*

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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