Untitled sheet

First Name*

Last Name*

Email Address*

Phone*

Phone

Address*

Date of Birth*

Year Level*

Year 12

Year 13

Ethnicity*

Outdoor hobbies, programmes or adventures:*

Please give bullet point details of any outdoor/environmental hobbies, programmes or adventures you lead or have participated in. (1500 characters max):

Do you have any dietary requirements?*

Please provide as much information as possible e.g. vegan, vegetarian, gluten-free, dairy-free, allergic to peanuts etc. Write in NONE if you have no dietary concerns. If you are selected for BLAKE Inspire, we cannot change your dietary options halfway through the programme, so please be specific!

Do you have any medical/allergy/behavioural considerations?*

Please provide as much information as possible e.g. anxiety, allergies (and any medication needed), eating disorder, back pain, injuries etc. Write in NONE if you have no medical/allergy/behavioural concerns.

How confident are you around water?

This does not impact your selection but helps us to place you in the right groups if selected for BLAKE Inspire.

Confident - I can easily swim 50m/snorkel

Moderate - can be in the water but not confident swimming long distances

Poor - cannot swim

Please provide a brief 1-2 page max CV outlining any leadership, environmental, school, community or employed activities you have been involved with. We recommend looking online for a CV template if you are unsure. File must not exceed 8MB. Please upload a PDF file only.

Photo

Please provide a high resolution head and shoulders profile photo of yourself (at least 1MB but no more than 5MB). If selected for BLAKE Inspire, this will be used in our programme manual and in any publications. Please upload a JPG or PNG file only and ensure it is close up, not a "fun photo of you on an adventure", but a head and shoulders photo please).

Reference

Please provide a 1-2 page written reference from your teacher/school principal or someone able to comment on your character, skills and suitability as a BLAKE Inspire delegate. File must not exceed 8MB. Please upload a PDF, JPG or PNG file only. If you do not include a reference or only provide referee details for us to contact, your application will not be considered.

File Upload*

Drag and drop files here or

Programme Preference*

13-17 April 2025 Auckland

1-5 December 2025 Auckland

Cost

We have expanded BLAKE Inspire to support 105 delegates throughout the year, and will be offering the programme through at least 45 fully subsidised scholarships and 95 partially subsidised positions at $875 (GST included). Please specify if you would be able to pay this cost if selected or if you would like to attend on a full scholarship (45 places available).

Able to pay $875

Need a scholarship

Caregivers Name*

Caregivers Email*

Caregivers Phone*

Phone

Have you done Blake Inspire before?*

Yes

Send me a copy of my responses

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