www.ats.co.nz

Name Day Time PhoNe

aDDress mobile

email

aTs shareholDer Number birTh DaTe

aTs shareholDer Name relaTioNshiP To shareholDer

Please complete this application form and attach:

• Aletteroutlininghowthisscholarshipwilladvanceyourleadershipinyourco-operativeandthecommunity.(Maximum1000words)

• ApersonalCV

• Thenameandcontactdetailsoftworeferees

• Signedtermsandconditions

Scholarship Process

ApplicationscloseSaturday31August2013.

ReturnyourcompletedscholarshipformbysendingtoATS,C/OMarketing,POBox131,Ashburton,orbydroppinginatanyATSstore.

AshortlistofcandidateswillbeinterviewedbyaSelectionPanel.

Ashburton Trading Society Ltd

50th Anniversary Scholarship

ATS 50Th AnniverSAry SchoLArShiP 1

50CELEBRATING

YEARS

Please read the following carefully, sign and attach to your application

The ATS scholarship criteria are:

• ThescholarshipisopentoATSshareholdersonly.

• Twoscholarshipswillbeofferedasaoneoffoccurrencetocelebratethe50yearsofATSwithacombinedvalueofupto$10,000.

• Thescholarshipistobeusedforstudyduring2014.

• Thescholarshipmaybeheldwithanyotherscholarship,bursary,prizeorfellowship,unlesstheconditionsofthealternativeawardprecludeit.

• ThattheSelectionPanel’sdecisionisfinalandnocorrespondencewillbeenteredinto.

By signing the application form the applicant agrees that and gives ATS permission to:

• Promotethescholarshipandwinnersthroughoutallmediaandthroughtheco-operativespublicationsincludingelectronicchannels.Thismayincludebutisnotlimitedtoyournameandpictureforpromotionalmaterial.

• Allapplicants,bysigningtheapplicationform,givepermissiontoATS,andtheirstudyprovidertoexchangeinformationaboutthemforthepurposeofassessingapplications,selectingcandidatesforthescholarship,andifawardedascholarship,forthepurposeofdistributingandobtaininginformationduringandfollowingthecompletionofstudies.

• Haveauthoritytocontactyourreferees.

I have read and agree to the terms and conditions, and to the best of my knowledge all information provided in this application is true and correct.

sigNeD

DaTe

If under 18 signed by a legal guardian

sigNeD

Name

RelATiOnSHiPTOAPPliCAnT

DaTe

ATS 50Th AnniverSAry SchoLArShiP 2