SURNAME: ……….
Student ID Number ……….
APPLICATION FOR GLOBAL HEALTH STUDY AWARD
1065Note: It is the responsibility of applicants to provide all the information requested.
All applications should be A4 sized, single sided and not presented in any form of folder
PERSONAL DETAILS NAME IN FULL:
Ms/Miss/Mrs/Mr...………...
...……...
Term Address... Permanent Address...……….
... ...………...
... ...………..
Telephone: ( )... Telephone: ( )...………
*
E-Mail address: ...(Contact is by email)
OTHER SOURCES OF FUNDING
Funding Applied For: _____________________________ _____________________________
_____________________________ _____________________________
_____________________________ _____________________________
Funding in Receipt Of: Period Funding has been provided for: Annual Value:
_____________________________ _____________________________ __________________
_____________________________ _____________________________ __________________
_____________________________ _____________________________ __________________
Degree for which you are enrolled:………...…...
Campus: Auckland
Palmerston North or Extramural
Wellington
1
ACADEMIC RECORD
Applicants must attach copies of academic records completed at tertiary institutions OTHER THAN Massey University.
SUPPORTING STATEMENT
To complete this application you must answer the question posted on the last page of this application
DECLARATION I consent to:
• The disclosure of personal information I have provided on this form, to staff within the University, for the purpose of assessing my application for a scholarship.
• The Scholarships Office obtaining any personal information about me which is required for the purpose of this application.
• Publication of my name and details of any scholarship which I am awarded.
I confirm that the information I have provided on this application form is true and correct and I have read and understand the regulations for the Global Health Study Award and agree to abide by them should I be offered and accept the award from Massey University.
Signature: ………. Date: ………..
Please physically post the application to the following address:
Scholarships
Graduate Research School Massey University Private Bag 11-222
PALMERSTON NORTH 4442
DISCLOSURE OF INFORMATION
The University undertakes to collect, use and store the information you provide in this application according to the principles of the Privacy Act 1993.
2
ESSAY (SUPPORTING STATEMENT)
In the space below, please write an essay in approximately 250 words expressing why you want to study abroad, what about the host country and the paper interests you most, and why the qualities of this particular paper support your personal, academic, and career goals.
3
