Application Form Page 1

universitiesnz.ac.nz

Application Form Page 1

SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)Application ChecklistIf you are currently enrolled at a New Zealand university, or if you graduated from a NewZealand university within the last five years, send your application to the ScholarshipsOffice at that university.Otherwise send your application to Universities New Zealand.You must correctly fill out the application form and include all documents listed belowand requested in the Regulations. Incomplete applications will not be considered.Check that the following are included:Application ChecklistApplication Form pages 1 to 7Certified proof of NZ citizenship or Permanent Resident status (see page 1)A certified copy of your Academic Transcript (see page 2)A list of publications and research achievements (see page 2)A summary of employment history (see page 2)Expanded information on your research etc. (see page 3)A breakdown of your estimated costs (see page 5)This form must be received by 1 March


Application Form Page 1SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)PERSONAL DETAILSFull nameMr/Miss/Ms/MrsEmail AddressMobile Phone NumberAddressInclude Post CodePhone NumberAddress for correspondence (if different from that given above):AddressInclude Post CodePhone NumberPlace of birthDate of birthPlease attach certified proof of New Zealand citizenship or Permanent Resident status.Application Form Page 1This form must be received by 1 March


Application Form Page 2SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)ACADEMIC TRANSCRIPTA copy of your Academic Transcript can be provided by the Scholarships Office throughwhich you are applying.If you are applying directly to Universities New Zealand you must include a certified copyof your Academic Transcript with this application.ACADEMIC RECORDInstitutionYears AttendedFromToQualification(gained or in progress)PUBLICATIONS AND RESEARCH ACHIEVEMENTSAttach a list of your academic publications and a summary of any other researchachievements.EMPLOYMENT HISTORYAttach a summary of your employment history (role, employer, dates, responsibilities).This should show your current or most recent role first.PROPOSED PROJECT OR PROGRAMMEUnder which category are you applying? Please tick the appropriate box.Science and Technology (includes Agriculture and Conservation)Engineering and Manufacturing (includes Architecture and Design)Business and CommerceApplication Form Page 2This form must be received by 1 March


Application Form Page 3SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)PROPOSED PROJECT OR PROGRAMME (continued)Give a brief outline below of the original work or research you propose to undertake.Attach a separate document where this outline is expanded.In the document also describe:- how your qualifications and/or work experience relate to the proposed project.- how the results of your proposed project will directly benefit New Zealand and itspeople.- if you intend to carry out all or part of this project/research overseas, why it isunable to be carried out in New Zealand.At which university will this project take place?In which department?If the research/project is part of a degree programme, which qualification?What is the required time period for the term of the award?Start DateEnd DateNOTE:These awards normally have a term of 1 year.Application Form Page 3This form must be received by 1 March


Application Form Page 4SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)SCHOLARSHIPS/AWARDSList any scholarships or awards that you have already been given to support yourpostgraduate study:Scholarship/Award Value (NZ$) Date AwardedList any scholarships or awards for which you have applied to support your postgraduatestudy, where the decision has not yet been made:Scholarship/Award Potential Value (NZ$) Date of ApplicationApplication Form Page 4This form must be received by 1 March


Application Form Page 5SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)______________________________________________________________________CURRENT FINANCES AND PROPOSED BUDGETCurrentAre you currently employed? (circle one)YesNoIf you are currently employed please state:the name of your employer____________________________________________________your annual salaryNZ$ _____________________________________________________what salary will you receive from your employer during the term of this award?NZ$ProposedTotal amount estimated as a living allowance:NZ$Total amount estimated for expenses:Funds gained to date:TOTAL FUNDS NEEDEDNZ$NZ$NZ$Attach a separate document to show the breakdown for each of these estimates.Application Form Page 5This form must be received by 1 March


Application Form Page 6SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)REFEREESGive the names of two people whom you have asked to provide confidential referencesIf you are applying through your university your referees should send their reports to theScholarships Office at your universityIf you are applying directly to Universities New Zealand your referees should send theirreports to the Scholarships Manager at Universities New Zealand.Your referees must ensure that their reports are received by 1 March.Title/NameAddressPhone NumberEmailTitle/NameAddressPhone NumberEmailApplication Form Page 6This form must be received by 1 March


Application Form Page 7SURNAME………………………………….Student I.D. Number………...…………The Todd Foundation Awards for Excellence (Universities)APPLICANT’S DECLARATIONI have read and understood the regulations for the Todd Foundation Awards forExcellence (Universities) and agree to abide by them.Signed: ______________________________________Date:_________________________________________STATEMENT BY DEPARTMENT CHAIR or HEADI confirm that should this person be granted a Todd Foundation Award for Excellence(Universities), the necessary facilities, material, equipment and adequate supervision willbe available for the proposed research programme.Name:_______________________________________________Position:_____________________________________________Signed: _____________________________________________Date:_______________________________________________Application Form Page 7This form must be received by 1 March


The Todd Foundation Awards for Excellence (Universities)Universities New Zealand Privacy DeclarationI understand that:- the information I have provided in this application form and in the attacheddocuments will be used for the purposes of assessing my application for thisscholarship.- Universities NZ may obtain any personal information about me that isnecessary to assess my application, including academic results fromorganisations such as NZQA.- personal information contained in my application will be made available tomembers of the Selection Committee for this scholarship.- in assessing my application members of the Selection Committee will usereferences received from the individuals that I have nominated.- Universities NZ undertakes to store and dispose of my application inaccordance with the Records Management policies and procedures ofUniversities NZ. No part of the application can be returned.Should I have reason to believe that information held about me is incorrect Ihave the right of access to, and correction of, that information.I acknowledge that the personal references from the persons I have named areobtained on the strict understanding that they are confidential and that I maynot have access to those references through Universities NZ.I agree to co-operate with any publicity for this scholarship and understand thatsuch publicity may include material supplied with my application.I, __________________________________agree to the above conditions inrespect of this scholarship application.Signed: ______________________________________Date:_________________________________________Privacy Declaration


Advice for ApplicantsPublications and Research AchievementsIf there are no publications or research achievements to list as part of the applicationmark the appropriate box on the Application Checklist as ‘N/A’.Employment HistoryIf there is employment history relevant to the application then mark the appropriate boxon the Application Checklist as ‘N/A’.Part time teaching, tutoring, etc. at university is relevant to the application.Application Due DateApplications must arrive by the date shown on the application form. No undertaking is givento accept late applications.RefereesIt is the applicant’s responsibility to contact referees and ask them to submit their reports ontime and to the correct office.References must be clearly marked with the applicant’s full name and the name of thescholarship for which it is being submitted.DocumentationDo not send original birth certificates or other original documents. Send only copies that havebeen certified by a JP, a solicitor or a university staff member.Universities New Zealand accepts no responsibility to return any documents.Application LayoutDo not put the application into any sort of folder.Do not double side any pages.Attach all pages with ONE staple in the top left hand corner.All pages should be A4 size.QuestionsAny questions regarding eligibility, particularly with regard to the residency criterion, or howto apply should be directed to the Scholarships Office at your university or toscholarships@universitiesnz.ac.nzTodd Excellence Awards - Advice for Applicants

More magazines by this user
Similar magazines