Cyril Smith Legacy Fund - Paralympics New Zealand

Who can complete this form

You may complete this form for yourself, on behalf of an organisation, or on behalf of an athlete who is not able to do so for themselves. Please Note: This web form cannot be saved. Please complete it in one session, and make sure to submit when finished.

I'm completing this form...*

For myself

On behalf of an organisation

On behalf of an athlete

Name of the person completing this form*

First Last

Personal details

Athlete name*

First Last

Organisation name*

Are you over 18 years of age?*

You are still eligible to apply if you are under 18 but we will need information about a parent or guardian.

Over 18 years

Under 18 years

Date of birth*

Email*

We will contact this email address about your application

Phone

Enter your phone number here:

Address*

Street Address Address Line 2 Suburb City/Town Postcode

Organisation physical address

Street Address Address Line 2 Suburb City/Town Postcode

Ethnicity

Asian

European

Māori

MELAA (Middle Eastern/Latin American/African)

Pacific Peoples

Other

Gender

Your connection to Canterbury

Select both if applicable. To be eligible for this fund you must either reside in and/or compete for Canterbury.

I reside in Canterbury

I compete for Canterbury

Parent or guardian*

To be completed if the applicant is under 18 years of age.

First Last

Parent or guardian's email*

Parent or guardian's phone*

Achievements and goals

Please outline your sporting achievements in the past 12 months.*

Please outline your organisation's accomplishments in the past 12 months relating to Para sport.*

Please outline your goals for the next 12 months.*

Funding details

Please tell us in a few words what the funds will be used for.*

Tell us in more detail how the funds will be used.*

Please explain the difference this funding will make to you or your organisation.*

If the same funding applied for has been received previously, applicants must demonstrate an improvement in performance, rankings, participation numbers, etc.

What is your bank account number?*

How much do you need in total*

How much of this can you contribute?*

Total funds applied for*

Please attach 2 quotes.

Drop files here or

Accepted file types: pdf, doc, docx, txt, jpg, jpeg, gif, png, Max. file size: 50 MB, Max. files: 20.

If 2 quotes cannot be provided, please explain why.

Attach any other supporting documentation (optional)

Drop files here or

Accepted file types: pdf, doc, docx, txt, jpg, jpeg, gif, png, Max. file size: 50 MB, Max. files: 20.

Has the applicant ever applied to the PNZ Cyril Smith Legacy Fund before?*

Yes

No

Please attach evidence that you either reside in Canterbury, or compete for Canterbury*

E.g., bank statement, utility bill, certificates of residency, club membership details, etc.

Drop files here or

Accepted file types: pdf, doc, docx, txt, jpg, jpeg, gif, png, Max. file size: 50 MB, Max. files: 20.

Have you applied to any other source for this funding?*

Yes

No

Please provide dates of the application and detail of the funding applied for.*

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Apply for Funding from The PNZ Cyril Smith Legacy Fund

PNZ Cyril Smith Legacy Fund application

Who can complete this form

Personal details

Para sport classification

Achievements and goals

Funding details

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