Application Form Page 1

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Application Form Page 1

This form must reach the ScholarshipsOffice of your university by 1 MarchApplication Form Page 1SURNAME……………………….Student I.D. Number………………NEW ZEALAND VICE-CHANCELLORS' COMMITTEEThe Kiwi Music ScholarshipChecklistPlease Note: If you graduated from a New Zealand University within the last five years, youmust send your application to the Scholarships Officer at that University.You must correctly fill out the application form and include all documents listed below andrequested in the Regulations and Guidelines for Applying. Incomplete applications will not beconsidered.Please tick documents attached:√NZVCC Application Form page 1 (Checklist)NZVCC Application Form page 2NZVCC Application Form page 3NZVCC Privacy FormCertified copy of Birth Certificate (or other evidence of citizenship)Certified copy of academic recordOriginal or certified copies of other awards and achievements relevant to theScholarshipStatement of your proposed programme of study and, if possible, evidence thatyou would be accepted by the institutionA budgetA CD of you in performance and any other evidence that you judge relevant to theapplication• Recordings must be presented as a compact disc and the length of the entire recording should be atleast thirty minutes, but no more than forty minutes in duration. Recordings submitted in DVD formatwill only be accepted from Conductors.• Recordings should have been recorded recently (within 12 months from the date of application) andmust be accompanied by a tracklist. If the work is not well known the applicant may be asked toprovide a copy of the score. All recordings should be clearly marked with the applicant’s nameand instrument/voice type.• Each recording should have at least three contrasting pieces.• Applications must state the date and place where the compact disc was recorded.• Applications must name the associated artists on the recording.• Each track should be unedited; the committee ask that certification be provided as evidence.Office Use OnlyDate Rec’d Complete Acknowledge Receipt Database Forward to NZVCC


Application Form Page 2SURNAME………………………………….Student I.D Number…………………………NEW ZEALAND VICE-CHANCELLORS' COMMITTEEThe Kiwi Music Scholarship_______________________________________________________________________________________PERSONAL DETAILSNAME IN FULL: Ms/Miss/Mrs/Mr/Dr.............................................................................................................................................................................................................................................................................................Term Address:......................................................Permanent Address:........................................................................................................................................ .................................................................................................................................Postcode:...............................................................................Postcode:.....................Telephone: ( ) ............................................... Telephone: ( ) .............................................................Cellphone: .......................................................... E-mail address: ................................................................ARE YOU A NEW ZEALAND CITIZEN? (Please circle one)YesHAVE YOU COMPLETED OR ARE YOU COMPLETING THE REQUIREMENTS FOR ANHONOURS OR MASTERS DEGREE IN MUSICAL PERFORMANCE FROM A NZ UNIVERSITY?(Please circle one)Yes_______________________________________________________________________________________REFEREESGive the names of two persons whom you have asked to forward confidential references to theScholarships Officer of your university. They must testify to your qualifications and ability to carryout the proposed study. Your referees should send their reports to the Scholarships Office, by 1March.Name: ..................................................................... Name: ......................................................................Address: .................................................................. Address: ................................................................................................................................................... ................................................................................................................................................................... ................................................................................................................................................................... ..................................................................................NoNo_______________________________________________________________________________________DECLARATIONI have read and understood the regulations and guidelines for The Kiwi Music Scholarship and agree toabide by them.Date : .............................................................. Signature: ............................................................................


Application Form Page 3SURNAME................................................................Student I.D. Number..................................................ACADEMIC RECORDWill be supplied by the New Zealand University through which you are applying.Please include a certified copy of your academic record if:1. You are applying directly to the NZVCC, OR2. You have studied overseas.TERTIARY EDUCATION RECORDInstitution Place and Country Years AttendedFrom ToDegrees, Diplomas orCertificates gainedPROPOSED COURSE OF STUDYIf the Regulations to this Scholarship do not already request a statement of your proposedcourse of study then you must attach a statement detailing your proposed research includingan outline of the methods of investigation you propose to adopt. Attach a list of publications,if applicable.TITLES OF THESES (IF APPLICABLE).................................................................................................................................................INTENDED STUDYAt which university do you intend to study?..........................................................................In which department?..............................................................................................................For which degree?....................................................................................................................SCHOLARSHIPS/PRIZESList Scholarships/Prizes you have received to date: .......................................................................................................................................................................................................................................................................................................................................................List Scholarships/Prizes you have applied for: ………………………………………………………………………………………………………………………………………………..………………………………………………………………………………………………..


BUDGETCost of Study:1 ST YEAR 2nd YEAR 3rd YEARFees NZ$ NZ$ NZ$Travel NZ$ NZ$ NZ$Extra tuition, master classes(incl. books)Living expenses (incl.accommodation, meals,medical insurance,telephone)SubtotalTOTAL(years 1 and 2)NZ$ NZ$ NZ$NZ$ NZ$ NZ$NZ$ NZ$ NZ$NZ$Funds Gained to date:ALREADY CURRENTLYGAINED APPLIED FORScholarships and prizes (please detail) NZ$ NZ$Savings NZ$ -----------Tuition fee scholarship (from overseas NZ$NZ$school)Loan (bank, family) NZ$ NZ$SubtotalTOTAL (Funds Gained)NZ$NZ$*NZ$TOTAL Cost of Study $Less TOTAL Funds Gained: -$TOTAL Funds Required: $.....................*The last figure will give us the most accurate idea on the day of what students require.If you are recommended for a scholarship we will be asking for updated information (i.e. subtotal of scholarshipscurrently applied for) so that the Trustees can make a decision as to level of funding to award.


New Zealand Vice-Chancellors’ CommitteeREFEREE’S REPORTApplicant’s Name: .......................................................................................................................Student ID Number: .....................................................................................................................Scholarship (s) Applied for: .........................................................................................................This report is due by: (Date) ........................................................................................................____________________________________________________________________________Please provide a confidential reference (ACADEMIC or PERSONAL), on or attached to this form, for the above namedstudent. This reference will only be used by the Scholarships Selection Committee in determining the applicant’s eligibilityfor the scholarship.Where to send this report1. To the Scholarships Officer at the applicant's university.2. Or, to the Scholarships Manager at the NZVCC, PO Box 11915, Wellington 6142, if the applicant is applying directly to theNZVCCReferee’s Name: (Pls Print) .........................................................................................................University/Dept: ...........................................................................................................................Signature: .............................................................................Date: ..............................................


New Zealand Vice-Chancellors’ CommitteeREFEREE’S REPORTApplicant’s Name: .......................................................................................................................Student ID Number: .....................................................................................................................Scholarship (s) Applied for: .........................................................................................................This report is due by: (Date) ........................................................................................................____________________________________________________________________________Please provide a confidential reference (ACADEMIC or PERSONAL), on or attached to this form, for the above namedstudent. This reference will only be used by the Scholarships Selection Committee in determining the applicant’s eligibilityfor the scholarship.Where to send this report1. To the Scholarships Officer at the applicant's university.2. Or, to the Scholarships Manager at the NZVCC, PO Box 11915, Wellington 6142, if the applicant is applying directly to theNZVCCReferee’s Name: (Pls Print) .........................................................................................................University/Dept: ...........................................................................................................................Signature: .............................................................................Date: ..............................................


NZVCC PRIVACY FORMThe information requested in this application form and your academic record will be used for the purposes ofassessing your application for the Scholarship(s) for which you are applying. Personal information contained inthis application will be made available to members of the Selection Committee for this award, the membership ofwhich is detailed in the award regulations. The New Zealand Vice-Chancellors’ Committee will use referencesfrom third parties designated by yourself, in assessing your application.The New Zealand Vice-Chancellors' Committee undertakes to store your application in a secure place in the eventthat you are successful in gaining an award or are selected as a reserve candidate for an award, and to destroy yourapplication 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 either your application or your academicrecord is incorrect, you have the right of access to, and correction of, that information.Personal references from the persons you have named are obtained on the strict understanding that they areconfidential, and you may not have access to those reports through the New Zealand Vice-Chancellors’ Committee.Applicants shall agree to the New Zealand Vice-Chancellors’ Committee obtaining their academic results fromorganisations such as NZQA, necessary to assess their application.Applicants shall agree to co-operate with any publicity of the scholarship for which they have applied. Suchpublicity may include material provided with your application, photographs and interviews with scholarshiprecipients.I, ................................................................................................... agree to the above conditions in respect ofthis scholarship application/s.Signed: ........................................................... Date:.......................................................................ADVICE TO APPLICANTSApplications must arrive by the date shown on the application form. No undertaking is given to acceptlate applications.It is your responsibility to contact your referees, and ask them to send their reports:For graduate scholarships: To the Scholarships Officer at the university you are attending.For undergraduate scholarships: To the New Zealand Vice-Chancellors’ Committee, PO Box 11915,Wellington 6142.Referees should not be asked to send their reports to you, as they must have the opportunity to becompletely frank.References MUST be clearly marked with your full name AND the name of the scholarship for whichyou are applying.Please do not send original birth certificates or other original documents. Send only copies that havebeen certified by a J.P, a solicitor, or a staff member in the university or polytechnic registry, or yourschool principal. Please do not send a CV unless this is specifically requested. The New Zealand Vice-Chancellors' Committee accepts no responsibility to return any documents.Please do not put your application into any sort of folder. Simply attach all pages with ONE staple in thetop left hand corner. All pages should be A4 size.If you have any queries regarding your eligibility or how to apply, please contact the Scholarships Officerat the university, or Career Adviser at the school, you are attending.

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