13/3/2001 Educational Award Scheme

Australasian Hydrographic Society Education Award Panel PO Box 533, Earlville QLD 4870, Australia Ph: +61 424 094 546, Email: [email protected] APPLICATION FORM

Education Award 2017

The Australasian Hydrographic Society offers an Annual Education Award of AUD $ 3,500

The award is open to students studying or researching in maritime disciplines including:

- Hydrography – Nautical Charting – Surveying at Sea - Coastal Studies – Coastal Zone Management - Offshore Resource Surveys and Management - Port Development and Maritime Engineering - Law of the Sea - Marine Cartography - Environmental Studies - Marine Geology and Geophysics

Closing Date – Friday 19 May 2017

Application Forms are available from the Australasian Hydrographic Society Web Site http://www.ahs.asn.au A copy of the application form is attached to this brief

For further information please contact The Australasian Hydrographic Society – Education Award Panel Telephone: +61 424 094 546 Email: [email protected] Australasian Hydrographic Society Education Award Panel PO Box 533, Earlville QLD 4870, Australia Ph: +61 424 094 546, Email: [email protected] APPLICATION FORM PART A (to be completed by the applicant):

Surname: ………………………………………………………………………………….

Given Names: …………………………………………………………………………..

Date of Birth: …………………………………………………………………………..

Contact Address: …………………………………………………………………………..

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Ph: ……………………………………….. Fax: ……………………………………....

Email: …………………………………………………………………………………

Nationality: …………………………………………………………………………………

Title of Course or Research Project (*600-1200 word outline of project to be included as attachment):

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Name of Institution: ……………………………………………………………………

Address of Institution: ……………………………………………………………………

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Duration of Course: ……………………….. Commencement Date: …………………… Australasian Hydrographic Society Education Award Panel PO Box 533, Earlville QLD 4870, Australia Ph: +61 424 094 546, Email: [email protected] APPLICATION FORM

Present Employment: (please give details of job title, responsibilities, name and address of employer)

Previous Employment: (please give names of employers, period of employment, job titles)

Professional Qualifications: (please give title and date of qualifications, names of professional institutions)

Academic Qualifications: (please give details of diploma or degree, level of award, institution and dates) Australasian Hydrographic Society Education Award Panel PO Box 533, Earlville QLD 4870, Australia Ph: +61 424 094 546, Email: [email protected] APPLICATION FORM

Personal Statement: (please explain the reasons for your application and identify the personal benefits the course will provide)

Signature: ………………………………………………………………………………….

Name: ………………………………………………………………………………….

Date: ………………………………………………………………………………….

Now please give the form to the educational/training establishment for completion of Part B. Australasian Hydrographic Society Education Award Panel PO Box 533, Earlville QLD 4870, Australia Ph: +61 424 094 546, Email: [email protected] APPLICATION FORM PART B (to be completed educational/training establishment):

Confirmation of place I confirm the applicant for the Educational Scheme holds an unconditional/conditional offer of a place for the course detailed on Page 1.

Signature: ………………………………………………………………………………….

Name: ………………………………………………………………………………….

Position: ………………………………………………………………………………….

Date: ………………………………………………………………………………….

Official Stamp of Institution:

Please return the completed form to (postal or email):

Australasian Hydrographic Society Education Award Panel PO Box 533 Earlville QLD 4870 Australia Ph: +61 424 094 546 Email: [email protected]