Local Heroes Application form

Coffee Culture Charitable Foundation Secondary School Local Heroes Awards

There are ten awards of $500 each available to students who are currently enrolled in Secondary Schools in the Canterbury, Otago and Waikato regions. They will be granted to students who need financial assistance to achieve their goals for their community-based project, or initiative that benefits their local community. Applicants should detail the specific way the $500 will be used, e.g. towards the purchase of specific equipment, training, organisational costs etc.

All applications must be signed by a teacher, coach or other official associated with the student and accompanied by a letter in support of the application from that person. Applicants must use the form below and include a photo that can be used by the Foundation in its announcement of the award winners.

Winners will also be required to submit a report detailing how the funds were used and how the community has benefited. Applicants are welcome to include links to any youtube clips that support your application.

Name:

Address

Phone:

Email:

Secondary School:

Please explain your community project:

Please explain how the award will be used and detail the costs involved in pursuit of your goal:

Please list any clubs, schools or organisations that are supporting your application:

Please explain why you believe you are a worthy recipient of the Local Heroes Award:

Please attach a photo of yourself

Please attach letter from your school, organisation, or club supporting your application:

Please attach any other supporting documentation you'd like us to consider in your application for a Local Heroes Award:

I understand that if my application is successful my photo may be used for promotional purposes by Coffee Culture and the Coffee Culture Charitable Foundation:

I declare that the information I have provided is true and accurate to the best of my knowledge: