Energy Education Trust NZ Undergraduate Scholarship

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1 Please Note: You must send your completed application to the Undergraduate Scholarships Administrator by 31 March You must correctly complete the application form and include all documents requested in the regulations. Incomplete applications will not be considered. Please tick documents attached: Application Certified copy of you Birth Certificate or evidence of citizenship or permanent residency Statement outlining your proposed course of study Personal Statement explaining reasons for applying for the Scholarship (including details of your interest in energy issues) Statement of your proposed future occupation References Office Use Only Date Rec d Complete Acknowledged Database

2 Application Are you currently enrolled in an undergraduate degree: YES NO Is it an Honours Year? YES NO PERSONAL DETAILS Student ID Number.. Name in Full Name: Ms/Miss/Mrs/Mr/Dr... Contact Address.... Telephone: ( ). Mobile: Address: Are you a New Zealand Citizen? YES NO Are you a Permanent Resident of New Zealand? YES NO REFEREES Give the names of two persons who you have asked to forward confidential references to the Undergraduate Scholarships Administrator by 31 March. They must testify to your qualifications and ability to carry out the proposed study. Name:.. Address: Name:.. Address: DECLARATION I have read and understood the regulations for the Energy Education Trust NZ Undergraduate Scholarship and agree to abide by them. Signature: Date:..

3 Statements Proposed Course of Study: Personal Statement: (Explaining reasons for applying for the Scholarship, including details of your interest in energy issues) Proposed future occupation:.

4 Referee s Report Applicants Name: Student ID Number: Please provide a confidential reference (ACADEMIC or PERSONAL), on or attached to this form. This reference will only be used by the Scholarships Selection Committee in determining the applicants eligibility for the scholarship. Referee s Name: (Please Print). University/Dept:.. Relationship to Applicant:.. Signature:.. Date:... Please return this form by the 31 st March to the Undergraduate Scholarships Administrator, Graduate Research Services, Clocktower Building, PO Box 56, Dunedin 9054, New Zealand.

5 Referee s Report Applicants Name: Student ID Number: Please provide a confidential reference (ACADEMIC or PERSONAL), on or attached to this form. This reference will only be used by the Scholarships Selection Committee in determining the applicants eligibility for the scholarship. Referee s Name: (Please Print). University/Dept:.. Relationship to Applicant:.. Signature:.. Date:... Please return this form by the 31 st March to the Undergraduate Scholarships Administrator, Graduate Research Services, Clocktower Building, PO Box 56, Dunedin 9054, New Zealand.

6 Closing date: 31 March Regulations Categories: Undergraduate 1 st year and later Summary: The Energy Education Trust is a charitable organisation which wishes to assist students to undertake full-time study in the fields of science, economics or engineering or related fields but with a specific interest in energy as it relates to the energy needs of New Zealand. Value: $5000 Tenure: One year Eligibility: Applications are open to students who are New Zealand citizens or permanent residents who are enrolled full time (or intending to enrol full time) at the University of Otago in the fields of science, economics or engineering or related fields. The student must demonstrate academic merit, the motivation to succeed and also be able to demonstrate a strong interest in energy issues and how this interest is related to their study and future career plans. Application: Every applicant must submit an application on the prescribed form to the University of Otago Scholarship Office no later than 31 March in the year of study together with two references. An applicant must also submit proof of age and residence status and provide a statement in regard to their current and intended future interests in energy. For further information please visit the Scholarship Office or

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