10-DAY YOUTH DEVELOPMENT VOYAGE - BIRTHRIGHT NZ

Voyage Placement Application Form

The Voyage Placement Application is for an applicant who would like to attend a 10-Day Youth Development Voyage
on Spirit of New Zealand. Birthright will fund the full berth fee of $1,800 to the successful applicant.

CRITERIA:
An applicant is eligible for a Birthright New Zealand Voyage Placement if they are:
between the ages of 15-18 years
a New Zealand citizen or a permanent resident of New Zealand
(if you are a resident, please attach your residency certificate)
able to demonstrate need
able to provide evidence that they will benefit from the experience.
from a family that has been a Birthright client for at least 12 months.
able to provide a referee statement endorsing the application.

GRANT RECIPIENTS ARE REQUIRED TO:

provide Birthright a written letter about your voyage and experience (you will be asked to write
this letter at the end of your voyage).
be available to meet with your local Birthright staff regularly for the year following the voyage.
be available to speak about your experience to the Birthright Member Society who sponsored you
be available to be interviewed by the Birthright NZ Website Manager about your experience.
agree to your photo and details be used for publicity purposes.
Please read all the questions carefully and answer as thoroughly as possible. If you have any questions, please
contact:
Name . Phone.. Email...............

APPLICANT INFORMATION
Applicants Name Voyage Number
.............................................................
First Names

Last Name

Country of Birth ..

School ..

Your Address .. .
..

Post Code

Home Phone (.) Applicants Mobile Parent Mobile

.

Applicants Email . Date of Birth

.

REFEREE DETAILS (e.g. School Principal, Kaumatua, Spirit Coordinator, Employer)

Name
First Names

Position ...........................................................................

Last Name

Relationship to Applicant .

Address

..
. Post Code

Phone (..) . Mobile............

Email..
CONT OVERLEAF

APPLICATION INFORMATION
Tell us why you want to go on Spirit of New Zealand.
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Why does your child require a Voyage Placement? (to be completed by parent or guardian)
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Describe any involvement you have in community activities or associations

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How does the voyage fit into your personal goals and how do you think this experience will help you achieve them?
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Tell us how you would be prepared to share your experiences with Birthright?
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Is there anything else you wish to be taken into consideration regarding your application?
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DECLARATION
I/We hereby declare all details contained in this application are true and correct.
Applicant Signature .

Date

Day

Parent(s)/Guardian(s) Signature . Date

Month
/

Day

Year
/

Month

Year

SUBMIT YOUR APPLICATION BY 31/01/2012

OFFICE USE ONLY
The applicant fulfills all the criteria and has our approval. (sign below)

....
Field Worker

Birthright Inc

Manager

.
Executive