Clyde Cunningham QSM Memorial Scholarship Application Form

Please submit this form and all attachments to MITO before 5pm Sunday 15 December 2024.

Before you complete the form, please ensure you have the following documents ready to upload:

A letter from you outlining how the scholarship is going to help you achieve your career goals, benefit your workplace and how you will manage the balance between study and work
Letter of permission/support from your employer, confirming the date you started employment, that you are working full-time and why they support your scholarship application
Evidence of your completed MITO automotive qualification (please provide a copy of your MITO certificate)
Your CV containing information about your employment history
Evidence of your New Zealand citizenship or residency (only a passport, birth certificate or residence visa is accepted).

PLEASE NOTE: Please ensure you fill out the form correctly - including ensuring the date fields are filled out as required, evidence documentation is in Word, PDF or JPEG format and under 5MB, and the I'm not a Robot check box is ticked.

Please read the Terms and Conditions before beginning your application to ensure you are eligible.

Terms and Conditions

Your Details

Full name *

Date of birth *

Home postal address *

Phone *

Email *

Name of the automotive qualification already completed through MITO *

Date completed *

Employer's Details

Employer's full name *

Employer's email address *

Business name *

Business postal address *

Business physical address *

Business phone *

Please upload the following documents. (in pdf, word or jpeg format and under 5 MB):

1. Please upload a letter written by you outlining how the scholarship is going to help you achieve your career goals, benefit your workplace and how you will manage the balance between study and work *

2. Please upload a letter of permission/support from your employer, confirming the date you started employment, that you are working full-time and why they support your scholarship application *

Please provide the full name of the person who has written your letter of permission/support. *

Please provide the job title of the person who has written your letter of permission/support. *

Please provide the contact number of the person who has written your letter of permission/support. *

3. Please upload evidence of your completed MITO automotive qualification (please provide a copy of your MITO certificate) *

4. Please upload your CV containing information about your employment history *

5. Please upload evidence of your New Zealand citizenship or residency (only a passport, birth certificate or residence visa is accepted) *

Personal Declaration

By ticking this box, I declare that all information provided is true and correct and I agree to the terms and conditions. *

Applicant's full name *

Application date - please select the date from the calendar provided *