PhD Completion Scholarship Application Form - Victoria University ...
PhD Completion Scholarship Application Form - Victoria University ...
PhD Completion Scholarship Application Form - Victoria University ...
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<strong>PhD</strong> <strong>Completion</strong> <strong>Scholarship</strong><br />
<strong>Application</strong> <strong>Form</strong><br />
Student ID Number<br />
Surname or Family Name<br />
Given Names<br />
Postal Address<br />
……………………………………………………………………………………………………………………..<br />
…………………………………………………………………………………………………………………….<br />
Telephone<br />
Email<br />
Dissertation Title<br />
Programme and School<br />
Names of Supervisors and Head of School from whom references have been sought:<br />
……………………………………………………………………………………………………………………..<br />
…………………………………………………………………………………………………………………….<br />
Tenure of scholarship sought to complete degree (please tick):<br />
3 months 6 months 9 months<br />
Were you to be awarded this scholarship, what would be the most feasible commencement date for you?<br />
Please note scholarships cannot commence before 1 March and 1 September in respective selection<br />
rounds.
2<br />
Write a brief account of the progress made on the dissertation from initial enrolment to the present time. Include<br />
mention of any factors that have hindered completion and whether they have now been addressed.<br />
This application form must be completed and accompanied by:<br />
a) copy of draft chapters completed to date. (These may be retrieved after the selection<br />
process from the <strong>Scholarship</strong>s Office.)<br />
b) detailed timeline and plan for the tasks yet to be accomplished<br />
c) letters of reference from supervisor and Head of School.<br />
d) the signed disclosure form<br />
References from supervisors and Head of School which fully and unconditionally support the predicted<br />
outcome of completion within the specified timeframe must be sent directly to the <strong>Scholarship</strong>s Office.<br />
There will be two selection rounds each year. The two deadlines for applications in 2005 are:<br />
Monday 27 February 2006 Monday 14 August 2006<br />
Applicant signature Date Completed forms should be returned to:<br />
Supervisors signature<br />
Date<br />
/ /<br />
/ /<br />
The <strong>Scholarship</strong>s Office<br />
<strong>Victoria</strong> <strong>University</strong> of Wellington<br />
PO Box 600<br />
Wellington
3<br />
Disclosure of Information<br />
I consent to:<br />
(i)<br />
(ii)<br />
(iii)<br />
(iv)<br />
the disclosure of the personal information given on this form to recipients<br />
within the university, for purposes related to my application for a scholarship<br />
and as required by protocols between the university and external agencies,<br />
including selection committees.<br />
the <strong>Scholarship</strong>s Office obtaining any information about me held by <strong>Victoria</strong><br />
<strong>University</strong> of Wellington, and any other tertiary institution which I have<br />
attended, relating to my application for a scholarship.<br />
the publication of my name and details of any scholarship which I may be<br />
awarded, together with any optional personal information which I may provide<br />
for this purpose.<br />
the disclosure of relevant information to sponsors of such scholarships.<br />
The <strong>Scholarship</strong>s Office undertakes to store your application in a secure place in the<br />
event that you are successful in gaining an award or are selected as a reserve<br />
candidate for an award, and to destroy your application to preserve its confidentiality<br />
in the event that you are unsuccessful in gaining an award.<br />
Should you have reason to believe that information held about you in your application<br />
is incorrect, you have the right of access to, and correction of, that information.<br />
I, …………………………………………………….. agree to the above conditions in<br />
respect of my scholarship applications administered through the <strong>Scholarship</strong>s Office<br />
of <strong>Victoria</strong> <strong>University</strong> of Wellington.<br />
Signed: ………………………………………………<br />
Date: ……………………