Methanex Undergraduate Leaders in Engineering Scholarships - Application Form

Personal Information

Full Name:

Student ID Number:

Street Address:

Suburb:

City:

Country:

Telephone(day):

Telephone(evening):

Cell Phone:

Email:

Educational Background

At which University do you currently study?

In which department?

For which degree?

In what year are you currently enrolled towards your degree?

Secondary School Information

List any scholarships or awards you have redceived to date, and any you are currently applying for:

Give details of any recent academic prizes or distinctions you have received:

References

Please provide two referees that can be contacted; an educational referee and a member of your community.

Privacy Declaration

The information requested in this Scholarship Application Form will be used solely for the purposes of assessing you Application for the Scholarship. Personal information contained in your Application form will made available to members of the Selection Committee. EnergySkills may obtain the following information from other parties:

• Details of your secondary and tertiary academic records from the New Zealand Qualifications Authority;
• Information obtained from the Applicant's referees

Declaration and Authorisation

I declare that the information contained in and provided in connection with this Application is true and correct. I acknowledge that giving false or misleading information is a serious offence. I further declare that if, for any reason, the information I have given is found to be incorrect or inaccurate, then I may have my Scholarship Application withdrawn.

I authorise EnergySkills to contact the referes I provided above and declare that I will ensure each referee is aware that they will be contacted for a verbal and/or written reference in support of my Scholarship Application.

Attachments

Use the following checklist to ensure that you have included in your Application all required attachments:

• A passport size photograph of yourself certified by someone who is not a relative, does not live at the same address as you do and who has known you for 12 months or more
• A certified copy of your academic transcript (results of 1st and 2nd year university study)
• A certified copy of evidence of your Citizenship (Birth Certificate, Certificate of Citizenship or the relevant pages of your passport)
• A current Curriculum Vitae (outlining your academic achievement and any extra curricular activities, including sport and community activities)
• A statement (of no more than A4 page) outlining why you should be awarded a Scholarship and what your career goals and aspirations are.

Photo:

Academic Transcript:

Evidence of Citizenship:

Upload your CV:

Statement: