Full Name

UOA Student ID No.

1. SELECTION CRITERIA Please note the following Selection Criteria for this Scholarship: Selection will be based on a combination of academic merit (measured by the grade point average assessed over the applicants two most recent years of full-time study, or equivalent), quality of research proposal, CV, referees reports, and alignment with the facultys strategic plan. NOTE: You do not need to calculate your GPA (domestic students) or GPE (international students) but applicants MUST have received an offer of place in The University of Auckland doctoral programme from the School of Graduate Studies before this application form can be accepted. If you have not already done so, go to www.apply.auckland.ac.nz to submit an Application for Admission. For any enquiries please contact scholarships@auckland.ac.nz.

2. DOCUMENT CHECKLIST You must correctly fill out the application form and include all documents listed below. Incomplete applications will not be considered. Please tick to show you have completed and / or attached the following:

You have received an offer of place in The University of Auckland doctoral programme from the School of Graduate Studies. You have attached one copy of your university academic certificate and transcripts showing your last two or more years of full-time study, or equivalent, if these years of study were not undertaken at The University of Auckland. (Note: This step is not required if these documents, covering your last two years or more of graded study, have already been provided with your AfA). Your Curriculum Vitae / Resume is attached (unless you want to use the same CV submitted in your AfA). You have either attached two signed references in sealed envelopes, or you have indicated the names and email addresses of referees that will be providing your references (as per page 4). If you have already provided two references in the format specified on page 8, with your AfA, then there is no need to supply these again.

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3. PERSONAL

DETAILS

Please complete the appropriate boxes

(a) UoA Student ID Number (b) Surname or Family Name First or Given Names Gender (M or F) (c) Address Town/City Home Ph Mobile Email University extn Date of Birth

4. NATIONALITY

AND

CITIZENSHIP

(a) Are you a New Zealand Citizen? (b) If not, are you a Permanent Resident of New Zealand? (c) Please tick if you are of Maori or Pacific Island origin

Pacific If you are not a Citizen or Permanent Resident of New Zealand, please complete 4(d) below: (d) Name of country on whose passport you are travelling

5. AWARDS, SCHOLARSHIPS & GRANT DETAILS - APPLIED FOR/AWARDED

Please detail all scholarships either held, or currently applied for, for doctoral study. (Confirmation of successful application outcomes is required by the Scholarships Office)
award name award name award name Amount Amount Amount Timeframe Timeframe Timeframe

Applied or Confirmed? Applied or Confirmed? Applied or Confirmed?

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6. Academic Details a) Proposed Study

If you are currently registered in a Doctoral programme, please give your start date:

Then complete questions 5b) & 5c) and onwards

If not currently registered, what is the doctoral programme you intend to study and the department?
(Doctoral Programme) (Department)

Intended Start Date

Please tick If the research that you propose to undertake/are undertaking is

Research Council reporting purposes)

health-related. (Note: this will have no bearing on your application but is solely for Health

b) Supervisor Details
Name of Proposed Main Supervisor

c) Tertiary Education Record

Academic Records: If your entire tertiary education was completed at The University of Auckland you do not need to submit a copy of your academic record. Otherwise one copy of your university academic certificate and transcripts showing your last two or more years of full-time study, or equivalent, will need to be submitted with this application (Note: This step is not required if these documents, covering at least your last two years of full-time study, or equivalent, have already been provided in the EOI process).

Institution

Place & Country

Years Attended From

Degrees, Diplomas or Certificates gained

To

7. Expected course or thesis results

If there is any course or thesis result unconfirmed at this stage, give particulars and the date when the result is expected. (a) (b) Examination course results Thesis results if applicable

/ /

/ /

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8. REFEREES
Name two academic referees whom you are asking to provide a confidential reference about you. Ask your referees to send their references (using the form provided and attaching a separate letter) to the Scholarships Office at The University of Auckland, Private Bag 92019, Auckland, New Zealand or by email to scholarships@auckland.ac.nz. Alternatively, if your referees have supplied one or more references in sealed official envelopes, these may be sent to us by post (Scholarships Office, The ClockTower, Private Bag 92109, Auckland Central) or hand delivered to the Scholarships Drop Box situated in The ClockTower at 22 Princes Street just outside the Student Information Centre. Name Position

__________________ ____________________________

______________________________ ______________________________ ______________________________

__________________ ____________________________

______________________________ ______________________________ ______________________________

9. PART-TIME ENROLMENT (DOMESTIC APPLICANTS ONLY)

Please tick if you have socially compelling reasons for part time enrolment, and attach the following: a compelling personal statement outlining the basis of your request (max 500 words) signed off by your main supervisor, together with supporting documentation (such as a letter from an appropriate medical practitioner, where the application is made on medical grounds); a signed and dated statement of support from your main/proposed supervisor; endorsement of supervisors statement by relevant Head of Department.

10. APPLICATION SUBMISSION

Applications may be returned as follows: By hand delivery or courier to: The Scholarships Office Drop Box, Student Information Centre, Room 112, The ClockTower, 22 Princes Street, Auckland Central Please note: All hard copy documents should be A4 and single-sided. Please staple the pages of your application ONCE at the top left hand corner. By mail to: The Scholarships Office, The University of Auckland, Private Bag 92019, Auckland Central, 1142. By email as a scanned copy to: scholarships@auckland.ac.nz

11. CLOSING DATEVARIES

The closing date varies with each faculty. For more information please consult the doctoral page of the Scholarships website (Go to www.auckland.ac.nz/scholarships, and click on Doctoral Scholarships). In addition, you may contact your faculty for information.

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Address including email

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For Mori applicants Only Please complete the following and attach to your application:

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13.

DECLARATION

OF

ETHNICITY
Yes (Not eligible for consideration as a Maori student; please do not complete this page) Iwi: _________________________________________________ _________________________________________________

(a) I am of New Zealand Mori descent (b) I am not of Mori descent (A) KOROWAI MORI Please list your main:

i.

ii. Hapu

iii. Marae: _________________________________________________

(B)

WHAKAPAPA
You must complete your Option A OR Option B below: (a) Option A: Whakapapa

________________ = ________________ ________________ = __________________ Paternal Grandfather Paternal Grandmother Maternal Grandfather Maternal Grandmother ______________________________ Father = ______________________________ Mother

4. Student Declaration:

Kaitono I, _____________________________ (name)(Applicant) declare that all information enclosed and attached to my __________________ Scholarship application form is true and correct and that no relevant information has Option B: Special - I do not know my whakapapa but I have provided been(b) withheld. I hereby permitCase Scholarships & Financial Support to verify any details provided proof in my of my New Zealand Mori ethnicity to the certifier. application form and on my budget worksheet.

__________________________

Signature: _____________________ Date: __________________

Gender:

Yes The certifier must still complete Section 16 below No Complete your whakapapa above and Section 16 below

(C)

CERTIFICATE

OF

WHAKAPAPA

You must now get a kaumtua, Mori Liaison Officer, marae representative or authorised person at your Iwi Rnanga representative to certify that you are of New Zealand Mori descent. The certifier must be of New Zealand Mori descent and can not be your sibling, spouse, parent or grandparent. (a) Certifiers Title Kaumtua Mori Liaison Officer Required Not required Marae Representative Iwi Rnanga Representative None of the above Not Eligible (do not continue)

Academic reference: For office use only:

(b) Certifiers Signature: _________________

Certifiers Name: ____________________

(c) Certifiers Contact No: (___) __________________ Date: _____ / ______ / ______

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For Pacific applicants only Please complete the following and attach to your application:

14.

DECLARATION

OF

ETHNICITY
Yes (Not eligible for consideration as a Pacific student; please do not complete this page)

(a) I am of Pacific descent (b) I am not of Pacific descent

(A) LINEAGE

________________ = ________________ ________________ = __________________ Paternal Grandfather Paternal Grandmother Maternal Grandfather Maternal Grandmother ______________________________ Father = ______________________________ Mother

__________________________ (Applicant)

(B) CERTIFICATION You must provide independent proof of your Pacific descent. Pacific students born outside of New Zealand must provide a verified copy of their passport or birth certificate. Students born in New Zealand will need to provide verified copies of their own birth certificate plus a birth certificate from at least one parent or grandparent of Pacific nationality. If a grandparents birth certificate is used, the birth certificates of the relevant parent must also be provided.

(C) VERIFICATION You must now get an authorised person from your Pacific community to certify that you are of Pacific Island descent. The certifier can not be your sibling, spouse, parent or grandparent. (a) Certifiers Title Priest or Pastor (if a member of a church community) Justice of the Peace Member of legal profession authorised to witness declarations None of the above Not Eligible (do not continue)

(b) Certifiers Signature: _____________________ Certifiers Name: __________________

(c) Certifiers Contact No: (___) __________________

Date: ______ / _______ / ______

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All Faculties The University of Auckland Doctoral Scholarship Referees Report

NAME of Applicant: REFEREES DETAILS: Name : on: Position:

Organisati THE UNIVERSITY OF AUCKLAND DOCTORAL SCHOLARSHIPS

* Length of time you have known the Applicant:...... * Capacity in which you have known the Applicant:.... * Number of candidates you have supervised to date:...

indicate the applicants potential to successfully complete a doctoral research degree: Top 5% Intellectual ability Research ability Academic standard Ability to transfer knowledge Resourcefulness / creativity Independence and initiative Adaptability to new situations Personal integrity Potential for future contribution in field Top 15% Top 30% Top 50% Lower 50% Not Known

Please

Please attach a letter commenting on the applicants achievements to date and your perception of their ability to undertake Doctoral level research (maximum of two pages please). When completed, please fax, scan or post a copy of this report with your letter to: The Scholarships Office, The University of Auckland, PO Box 92019, Auckland, New Zealand. Fax: +64 9 3082309 Email: scholarships@auckland.ac.nz (Please add the following subject line Reference for Doctoral Scholarship Applicant (Applicants name). Alternatively, if this report is provided directly to the applicant, please place it in a sealed envelope and sign across the seal. Thank you for your assistance

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