inclusive education postgraduate application form

8/3/2019 Inclusive Education Postgraduate Application Form

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Inclusive Education Postgraduate Award

APPLICATION FORM

Student InformationFamily Name:First Name/s:

Date of Birth:Postal address:Please provide evidenceof New Zealandcitizenship or permanentresidency:

(tick when attached)

Email address:Mobile number:Lincoln Student IDNumber:(if known)

Academic InformationCourse of Study atLincoln:

Please attach a copy ofyour academic transcript: (tick when attached)

Financial InformationFinancial assistance beingreceived or expected:(other scholarships,bursaries, awards,student allowances,Workbridge TrainingSupport Fund, TrainingIncentive Allowance,


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funding from EquipmentManagement Servicesand ACC etc)

What is your disability, injury, or illness?


How long have you had your disability, injury, or illness?


What barriers to study at Lincoln University do you face because ofyour disability, injury, or illness?


How would the Inclusive Education Award Reduce these barriers?


How would you use the Inclusive Education Award? (If possibleplease set out the costs involved)


Medical requirementsYour application mustinclude a recent medicalcertificate or assessmentfrom a healthprofessional, such as adoctor, specialist, orpsychologist. Thisdocument should provide

evidence of yourcondition, the length of



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time that you have hadthat condition, and thebarriers to study atLincoln University thatresult from it.

References

Please submit a confidential letter of reference with your application. Thisreference should provide evidence of your potential to complete a degree

Please provide the name, title, address, phone number and email addressfor your referee:Referee details:

Declaration:I declare that the information contained in and provided in connection withthis application is true and correct. I acknowledge that giving false ormisleading information is a serious offence.

Signature: Date:

Please submit your application to the Lincoln UniversityScholarships Office no later than 1 November.

Candidates shall submit applications directly to the followingaddresses:

Scholarships Office Phone: (03) 3252 811,extn: 8748 or 8582Lincoln University Email:

[email protected] Box 84 [email protected] 7647Christchurch Web: www.lincoln.ac.nz/scholar
http://www.lincoln.ac.nz/scholarhttp://www.lincoln.ac.nz/scholar


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PRIVACY PROVISIONS

The information requested in this application form and your academicrecord will be used solely for the purposes of assessing your applicationfor the Scholarship(s) for which you are applying. Personal informationcontained in this application will be made available to members of theSelection Committee for this award, the membership of which isdetailed in the award regulations.

Lincoln University undertakes to store your application in a secureplace in the event that you are successful in gaining an award or areselected as a reserve candidate for an award, and to destroy yourapplication to preserve its confidentiality in the event that you areunsuccessful in gaining an award.

Should you have reason to believe that information held about you ineither your application or your academic record is incorrect, you havethe right of access to, and correction of, that information.

Personal references from the persons you have named are obtained onthe strict understanding that they are confidential, and you may nothave access to those reports without the written authorisation of theauthor.

I, ............................................................................................ agree to theabove conditions with respect to my scholarship application(s) toLincoln University.

Signed:...........................................................Date:.......................................................

ADVICE TO APPLICANTS

Applications must arrive by the date shown on the application form. Noundertaking is given to accept late applications.

It is your responsibility to contact your referees, and ask them to send

their references to the Scholarships Office. References should beclearly marked with your name and the name of the scholarship(s) for


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which you are applying. Referees should not be asked to send theirreferences to you, as they must have the opportunity to be completelyfrank. Non receipt of referees reports or incomplete applications, mayprejudice your eligibility.

If requested please do not send original birth certificates or other

original documents. Send only copies that have been certified by a J.P,a solicitor, or a staff member in the university registry. LincolnUniversity accepts no responsibility to return original documents.

Please do not put your application into any sort of folder. Simply attachall pages with ONE staple in the top left hand corner. All pagesshould be A4 size.

If you have any queries regarding your eligibility or how to apply,please contact the Scholarships Office on 0800 10 60 10 [email protected].

REFEREES REPORT

Applicants Name:

Students ID Number:

Scholarship(s) Applied For:

This report is due by: (Date)______________________________________________________________Please provide a confidential reference (ACADEMIC orPERSONAL) on or attached to this form, for the above namedstudent. This reference will only be used by the Scholarships

Selection Committee in determining the applicantseligibility for the scholarship.

Please send this report to: Scholarships Manager, Lincoln University,P O Box 84, Lincoln 7647, CHRISTCHURCH.


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Referees Name: (Pls Print)Organisation:Signature: Date:

inclusive education postgraduate application form

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