The University of Waikato Academic Merit School Leaver Scholarship
A PPL I C A TI O N F O R M ( F O R ‘ G A P
YE A R ’ C AN DI D AT ES O N L Y )
Before applying, you must read the Scholarship regulations.
This application must be submitted to:
By post: The Scholarships Office
The University of Waikato
Private Bag 3105
HAMILTON 3240
or in person: Student Information desk/drop box
Level 2
The Student Centre – Te Manawa
The University of Waikato
Applications close at 5.00 pm on 6 February 2017.
Please ensure that all questions are answered and that all the required attachments accompany this
application form. You may jeopardise your chances of success if you do not complete your application
properly.
When preparing your application form and attachments, please do not use staples, special binding,
coloured ink or paper. To fasten documents together, please use paper clips or bulldog clips. This is
because all documents will be photocopied.
Y O U R P E R S O N AL D E T AI L S
NA ME A N D S T UD E NT ID
Family name
First name:
University of Waikato Student ID:
PO STA L A D D R ES S
For correspondence regarding this application
Street Number and Name:
Suburb:
Town/City:
Post Code
E-mail:
Home Phone:
Cell Phone:
The University of Waikato Academic Merit School Leaver Scholarship
A PPL I C A TI O N D E T AI L S
EL I G IB I LI TY
I took a ‘gap year’ in 2016:
Yes
No
Main ‘gap year’ activity:
If you have answered ‘no’, please stop now; this application form is for ‘gap year’ candidates only.
SEC O ND A R Y SC H O O L( S ) A TT END ED
Please list the secondary school(s) which you have attended.
School:
Years:
School:
Years:
School:
Years:
ST UD Y I NT E NT I ON S
Please indicate the qualification for which you intend to be enrolled as a full-time student in 2017:
Qualification:
Faculty/School:
Department:
A TTA C H M E NT S
Please attach the following to your application form:

A statement giving information on your activities during your ‘gap year’, your reasons for choosing
to spend the year in this way, and the benefits which you believe you gained from this year. You
are welcome to attach supporting documentation, e.g. a letter from a person of some standing in
the community (such as a teacher) outlining the benefits of your ‘gap year’

A brief curriculum vitae (of no more than four A4 pages in length) including a detailed record of
study at secondary level

A copy of your 2015 NCEA results (or equivalent)
It may strengthen your application if you are able to attach the following:

Supporting documentation, such as a letter from a person of some standing in the community (e.g.
a teacher), outlining the benefits of your ‘gap year’
The University of Waikato Academic Merit School Leaver Scholarship
C O ND IT I ON S
I understand that:
1. If I am offered a University of Waikato Academic Merit School Leaver Scholarship, and accept it, I will
only be eligible to be formally awarded the Scholarship if I will be enrolled at the University of Waikato
in the year of tenure and complying with any other specific requirements of the award.
2. The Scholarships Committee may terminate a Scholarship at any time and recoup any funds awarded,
if it is satisfied that the holder is not following the required programme or is not otherwise complying
with the conditions governing the Scholarship. The holder of a Scholarship shall have the right to appeal
to the Academic Board against any decision to terminate the award.
P R I V A C Y
D
E C L A R A T I O N
The information requested in the attached application form will be used solely for the purposes of assessing
your application for the Scholarship for which you are applying. Personal information contained in this
application will be made available to members of the Selection Committee, members of the Scholarships
Committee and staff of the Scholarships Office.
The University of Waikato undertakes to store your application in a secure place in the event that you are
successful in gaining an award or are selected as a reserve candidate for an award. The University of Waikato
undertakes to destroy your application to preserve its confidentiality, in the event that you are unsuccessful in
gaining an award. Should you have reason to believe that information held about you in either your application
or your academic record is incorrect, you have the right of access to, and correction of, that information.
Names of the recipients of this award will usually be made available to the Principal of their last secondary
school in April of the year of tenure.
S
I G N
Signature:
H E R E
Date: