PhD Completion Scholarship Application Form - Victoria University ...

PhD Completion Scholarship
Application Form
Student ID Number
Surname or Family Name
Given Names
Postal Address
……………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………….
Telephone
Email
Dissertation Title
Programme and School
Names of Supervisors and Head of School from whom references have been sought:
……………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………….
Tenure of scholarship sought to complete degree (please tick):
3 months 6 months 9 months
Were you to be awarded this scholarship, what would be the most feasible commencement date for you?
Please note scholarships cannot commence before 1 March and 1 September in respective selection
rounds.

2
Write a brief account of the progress made on the dissertation from initial enrolment to the present time. Include
mention of any factors that have hindered completion and whether they have now been addressed.
This application form must be completed and accompanied by:
a) copy of draft chapters completed to date. (These may be retrieved after the selection
process from the Scholarships Office.)
b) detailed timeline and plan for the tasks yet to be accomplished
c) letters of reference from supervisor and Head of School.
d) the signed disclosure form
References from supervisors and Head of School which fully and unconditionally support the predicted
outcome of completion within the specified timeframe must be sent directly to the Scholarships Office.
There will be two selection rounds each year. The two deadlines for applications in 2005 are:
Monday 27 February 2006 Monday 14 August 2006
Applicant signature Date Completed forms should be returned to:
Supervisors signature
Date
/ /
/ /
The Scholarships Office
Victoria University of Wellington
PO Box 600
Wellington

3
Disclosure of Information
I consent to:
(i)
(ii)
(iii)
(iv)
the disclosure of the personal information given on this form to recipients
within the university, for purposes related to my application for a scholarship
and as required by protocols between the university and external agencies,
including selection committees.
the Scholarships Office obtaining any information about me held by Victoria
University of Wellington, and any other tertiary institution which I have
attended, relating to my application for a scholarship.
the publication of my name and details of any scholarship which I may be
awarded, together with any optional personal information which I may provide
for this purpose.
the disclosure of relevant information to sponsors of such scholarships.
The Scholarships Office undertakes to store your application in a secure place in the
event that you are successful in gaining an award or are selected as a reserve
candidate for an award, and to destroy your application to preserve its confidentiality
in the event that you are unsuccessful in gaining an award.
Should you have reason to believe that information held about you in your application
is incorrect, you have the right of access to, and correction of, that information.
I, …………………………………………………….. agree to the above conditions in
respect of my scholarship applications administered through the Scholarships Office
of Victoria University of Wellington.
Signed: ………………………………………………
Date: ……………………