BLAKE Ambassadors Application

First name / Ingoa tuatahi*

Surname / Ingoa whānau*

Home address / Wāhi noho*

Street Address Address Line 2 City Country

Your Email / Wāhitau Īmēra*

Enter Email Confirm Email

Mobile number / Nama waea*

Age*

Date of birth / Rā whānau*

Gender / Ira tangata*

Ethnicity / Mātāwaka*

Use CTRL key to select multiple programmes.

University / Tertiary Institution / Employer*

Programme / Hōtaka applying for*

Use CTRL key to select multiple programmes.

If applying for more than one BLAKE Ambassador programme, what is your preferred option?*

Please give details of any leadership roles and/or positions of responsibility you hold (or have held).*

Please give details of your environmental interests and involvement.*

Please give details of any outdoor pursuits, expeditions or adventures you have participated in/been a member of and/or any awards or qualifications held.*

(e.g. Duke of Edinburgh, Spirit of Adventure, PADI etc.)

Discuss the greatest scientific challenge facing New Zealand today.*

Why would you like to be selected as a BLAKE Ambassador, and how would you share your experiences?*

Photo of yourself*

Please submit a high quality head and shoulders photo. Minimum file size 1MB. Maximum file size 3MB.

Accepted file types: jpg, jpeg, png, Max. file size: 3 MB.

Upload a PDF of your CV*

Maximum file size of 5MB

Accepted file types: pdf, Max. file size: 5 MB.

Please upload a reference letter.*

Maximum file size 3MB. References may come from employers, supervisors and lecturers.

Accepted file types: pdf, jpg, png, jpeg, Max. file size: 3 MB.

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