No Late Applications Will Be Accepted

Meadow Mushrooms Waterways Centre Master’s Scholarship

APPLICATION FORM Applications close at 5:00 pm on 15 May NO LATE APPLICATIONS WILL BE ACCEPTED

PERSONAL DETAILS Family Name: First Name(s) Postal address: Suburb: Town/City: Postcode: Country: Student ID: Citizenship: NZ citizen Holder of NZ residence class visa Other Telephone: (0 ) Mobile phone: (0 ) Email: Date of Birth

ACADEMIC INFORMATION Please indicate which Lincoln University University you are attending: University of Canterbury Programme of study: List all previous

tertiary institution(s)

attended:

RESEARCH TOPIC: Thesis title and course code:

Please attach a summary of your thesis research (up to 500 words).

The following information will be treated confidentially and released only to the scholarship selection committee.

FINANCIAL INFORMATION Indicate your intended means of financial support for this year. Mark all boxes that apply: (Include other scholarships, bursaries awards, grants, etc.) Student Allowance Part-time employment Parental support Student loan Bankloan/overdraft Training Incentive Allowance Other (please give details)

Provide details of your expected income and expenses for this year in the chart below: Expected annual income for this year Expected annual expenses for this year (Do not include student loan) $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL INCOME $ TOTAL EXPENSES $

TO BE ATTACHED:

A summary of your thesis research topic.

Original, or certified true, copies of your academic records (only if you have been previously enrolled at another tertiary institution: your Lincoln University or University of Canterbury academic record does not need to be attached).

Notes:

1. The regulations for this award are available from the Lincoln University and University of Canterbury Scholarships websites and offices. Please read them carefully and make sure you are eligible to apply.

2. ALL application documentation must be submitted by 5pm on 15 May to the Waterways Centre; please understand that material supplied cannot be returned. ADVICE TO APPLICANTS Applications must arrive by the closing date shown on the form. No undertaking is given to accept late applications.

Birth Certificates/Academic Transcripts: If requested please do not send original birth certificates or other original documents. If they are requested please bring your original to the Waterways Centre where a certified copy will be made. For students currently or last enrolled at UC or LU the Waterways Centre will provide the Canterbury or Lincoln academic record. Students previously enrolled at other universities/tertiary institutions must supply an official transcript from that university/institution.

Additional Material: Please note that only materials requested on the application form and/or in the regulations are to be submitted – e.g. do not attach a curriculum vitae unless you are requested to do so. In the interests of equity, any additional material will be removed from your application. Material submitted cannot be returned.

Please do not put your application into any sort of folder. Simply attach all pages of each application with ONE paper clip in the top left hand corner. All pages should be A4 size, printed on one side only.

DECLARATION In submitting this form I agree to my details being used for the purposes of assessing my candidature for the above-named scholarship(s). The information will be accessed only by necessary university staff and members of the selection committee(s) specified in the scholarship regulations. I understand my data will be held securely and will not be distributed to third parties. I understand that, when this information is no longer required for this purpose, official university procedure will be followed to dispose of my data. I understand that the information is held by the Waterways Centre for Freshwater Management, Christchurch, and that I have the right to access and correct my personal information.

I agree to take part in any publicity that may arise from the award(s), should I be successful with this application.

I have read, and I understand, the regulations for the above award.

I understand that documentation submitted for this application cannot be returned.

Full Name (printed): Signature:

Date: - -20

ACKNOWLEDGEMENT OF RECEIPT OF APPLICATION will be sent to your email address after the published closing date of the scholarship

For both Lincoln University and University of Canterbury applicants, please send completed application forms and documentation to: Suellen Knopick Administrator Waterways Centre for Freshwater Management University of Canterbury and Lincoln University 03 364 2330 Email: [email protected]

If you have any queries regarding your eligibility or how to apply, please contact the Scholarships Office: Lincoln University on 0800 10 60 10 or [email protected] or University of Canterbury on (03) 366 7001 or [email protected] 03/16