TEMPLATE NextGen Dairy Farmers programme – Canterbury TEMPLATE Enrolment Application for NextGen Dairy Farmers programme – Canterbury This form takes approximately 20 minutes to complete and is faster to complete on a computer than a phone. You can save this form and return to it later by scrolling to the bottom of this form and selecting the ‘Save and continue later’ button. If you need help completing this form, please phone Dairy Training on 0800 467 768 between 9am and 4.30pm. I am: I am:(Required) A Year 12 or 13 student Completing this form on behalf of someone Contact details Name(Required) First Last Email(Required) Enter Email Confirm Email PhoneDate of brith DD slash MM slash YYYY School Gender Male Female Other Applicant’s addressAddress Street Address Address Line 2 City/town ZIP / Postal Code National student numberPlease write ‘unknown’ if unsure Education professional or parent/caregiver’s contact details (optional)Name (teacher/caregiver)Please provide additional information if you are completing this form on behalf of someone else. First Last Relationship to applicant Email PhoneMore about youWhich ethnic groups do you belong to?Select as many as apply. Māori New Zealand European Australian British and Irish Chinese Cook Island Māori Fijian Filipino Samoan Tongan Tokelauen Other Other ethnicityOther ethnicity What is the name of your Iwi?You may provide more than one Iwi.Iwi 1Iwi 2Iwi 3 Add RemoveWhat is your citizenship or residency status? New Zealand citizen New Zealand permanent resident Australian citizen Australian permanent resident New Zealand residency visa Other Verification documentsSelect ONE of the options – you will be required to attach documents A copy of a birth certificate with place of birth stated as New Zealand, Australia, Cook Islands, Tokelau, or Niue A copy of a New Zealand or Australian passport – a current or expired passport is acceptable, but not not a cancelled passport A copy of a statement of Whakapapa, including date of birth, counter-signed by Kaumatua (if no birth certificate or passport exist) A copy of a passport AND a certificate of citizenship or letter of confirmation Tip: Simply take a photo of the document with your smartphone and upload it.A copy of a New Zealand or Australian passport(Required)Max. file size: 100 MB.A copy of a birth certificate with place of birth stated as New Zealand, Australia, Cook Islands, Tokelau, or Niue(Required)Max. file size: 100 MB.A copy of a statement of Whakapapa, including date of birth, counter signed by Kaumatua (if no birth certificate or passport exist)(Required)Max. file size: 100 MB.A copy of a certificate of citizenship or letter of confirmation(Required)Max. file size: 100 MB.A copy of an overseas passport with residency stamp(Required)Max. file size: 100 MB.More about youDo you live with the effects of significant injury, long term illness, disability or learning difficulty? Yes No How would you describe your impairment, disability, learning difficulty or long term medical condition? Hearing impairment Speech impairment Vision impairment Specific learning difficulty Mobility Psychological / psychiatric Other You selected 'other' please describeYou selected ‘other’ please describe Help us get to know youWhat experience have you had caring for animals?Do you enjoy spending time in the outdoors?What are you hobbies and/or interests?Why do you want to be a NextGen farmer?Interview days and timesWhich days and times are the best to ring you?e.g. Fridays and Saturdays, 6-7am, or 7-8pm Education historyWhat is the name of the last secondary school you attended? What is the highest level of achievement you hold from a secondary school? No formal qualifications 14 or more credits at any level NCEA Level 1 or School Certificate NCEA Level 2 or Sixth Form Certificate University Entrance NCEA Level 3 or Bursary or Scholarship Overseas qualification (includes intermediate Baccalaureate and Cambridge) Not known Other Character refereesPlease provide two referees (one from school and one from outside of school)1. Name (school referee)(Required) First Last Phone(Required)Relationship to you(Required) 2. Name (outside-of-school referee)(Required) First Last Phone(Required)Relationship to you(Required) Emergency contact detailsFirst and last name Relationship to you Emergency contact phone number DeclarationDisclaimer(Required)I understand that by completing this form I am applying to be one of the 15 NextGen future farmers as part of the NextGen Future Farmers Programme. If I am selected after having completed an interview in September 2024, I will complete 3-week pre-employment training in December on a Canterbury farm before starting as a trainee farm assistant working full-time on a Canterbury farm in January 2025. Yes
