Massey University Blues Award Application Form – Massey University Blues Sports Awards

Nominate an athlete for a Blues Award.

Apply yourself or nominate someone else for a Massey University Blues Award by completing this form.

First Name *

Surname *

Sport *

Massey Student ID *

Programme of study *

Name on award (as it will appear on award)

Mobile phone number *

Email *

NZ Postal Address *

What most accurately describes you? *

If you selected "other" above, please list

Please feel free to list your known iwi affiliations if desired

If you have listed iwi affiliations above, please indicate if you would like these to be acknowledged at the public Blues celebration and ceremony

Do you have athlete social media accounts? If so, please list these below.

What secondary school did you attend? *

Is the nominee enrolled in at least 45 credits over the period July (last year) to June (current year), or completing a degree or diploma in that period? *

What is your primary mode of study? *

Is the nominee expecting to finish their studies this year? *

Sporting Achievements

Please provide details (full date/location/town/country and placing) of your highest achievement at each level where relevant for the period August last year to July this year. Please note that team selection is not sufficient, nominees must provide information of actual games played.

University / Club Participation (1st August 2023 – 31st July 2024)

Regional Representation (1st August 2023 – 31st July 2024)

New Zealand Representation (including age group, university, senior) (1st August 2023 – 31st July 2024)

Other Sporting Achievements or Awards (1st August 2023 – 31st July 2024)

Current NZ ranking (if applicable)

If you have any team selections pending, or key events between your application submission and 31st July this year, please list these below so the Blues Committee can follow up for this information if required.

Please summarise (in paragraph form) your highest achievements during the nomination period. *

National Sports Organisation

National Sports Organisation / Governing Body

NSO Name *

Contact Name *

Position *

Phone / Mobile *

Email *

Photo Upload *

Click or drag files to this area to upload. You can upload up to 4 files.

Please upload a photo of the athlete in action in their sport (or in sport uniform). This photo may be used by Massey University on the website or social media, in the Blues Awards presentation and in promotion for future events.

Declaration and Privacy Statement

Declaration and Privacy Statement. Please note that your application will NOT be considered if you do not complete this section. To the best of my knowledge, the information provided in this nomination is true and correct. The Massey University Blues Selection panel and University & Tertiary Sport NZ have permission to access my academic results in the year of my application for the Blues Awards. In addition, I authorise my name, voice and picture and any other information given on this form to be used without payment in any broadcast, telecast, advertising promotion or in any way relating to this event.

Signed (please type in your full name) *

Recommendation

Recommend other athletes

If you know of any other athletes who may be eligible for this award, please provide their name, sport and email address.