DAIRYNZ SCHOLARSHIP

Application Form

1.  Personal Details - please complete the following sections

Name:
(First Names) / (Last Name)
Birth Date: / Age:
Ethnicity: / Gender:
Home Address: (include post code) / Term Address (if known): (include post code)
Contact Telephone No:
Mobile No:
Email:

2.  Academic Details

Last Secondary School attended:
Years attended: / 20____to 20____
NSN Number:
Intended Course of Study (Degree): (for the following year)
University (tick one box, if known): / Massey / Lincoln / Waikato
Student ID # (if known):
University applicants: Year at university in 2016

Secondary School Qualifications: Please enclose certified photocopied NZQA

Qualification and Achievement Summary results for each NCEA Level completed.

(a) NCEA Level 1 / (Tick when attached)
(b) NCEA Level 2 / (Tick when attached)
(c) NCEA Level 3 (If available) / (Tick when attached)

SCHOOL LEAVER APPLICANTS’ IMPORTANT NOTICE

Please summarise your Level 1, Level 2 and Level 3 (to date) NCEA results in the table below:

Subject Credit Summary

Level 1 Subjects / N / A / M / E / Total
Total
Level 2 Subjects / N / A / M / E / Total
Total
Level 3 Subjects / N / A / M / E / Total
Total

N – not achieved A – achieved M – achieved with merit E – achieved with excellence

APPLICANTS APPLYING FROM UNIVERSITY:

Your recent University results are of most interest to the Selection Panel and a

School Results Summary is not required. Please provide a copy of the official university results with your application.

Please also complete the tables below by summarising your Record of Achievements by categories.

Record of Achievements

Please include all your non NCEA qualifications and awards in the tables below:

Other Qualifications and Awards

Year / Description of the Qualification or Award

Sports/Cultural Activities

Year / Description of the Activities

Leadership Roles

Year / Description of the Roles

Checklist: Please include as many of the following items as are applicable to you:

i. / University results to date (applies to applicants attending university / (Tick when attached)
ii. / New Zealand Citizenship or Permanent Residence:
To be eligible for the Scholarship you must be either a New Zealand Citizen or Permanent Resident. Please provide evidence of your status. / (Tick when attached)
iii. / Please attach a written presentation that outlines your proposed future (and any present) involvement with the New Zealand Dairy Industry (500 words maximum). / (Tick when attached)
iv. / Please attach a written presentation that demonstrates your leadership skills and/or your involvement with community, sports or other activities (500 words maximum). / (Tick when attached)
v. / Please supply one testimonial or reference from your school or university to support your application. / (Tick when attached)
vi. / Please write a covering letter explaining your reasons for applying
for this scholarship. / (Tick when attached)
vii. / Are you a member of New Zealand Young Farmers? Yes / No

Please read the following carefully:

By signing this application form applicants who are selected for a scholarship give permission to DairyNZ to:

·  Publish information about them on the DairyNZ and other relevant websites for the purpose of advertising and promoting the DairyNZ Gap Year Scholarship.

·  Publish information about them in hardcopy publications for scholarship promotional purposes.

·  Use their services, by agreement, to promote the scholarships at selected career promotion events.

·  Use their services to visit, by agreement and arrangement, selected secondary schools to inform students of the advantages of the scholarship.

All applicants, by signing the application form, give permission to DairyNZ, Lincoln University, Massey University and The University of Waikato to exchange information about them for the purpose of assessing applications and selecting candidates for the scholarship.

Please indicate whether you have attended any of the following career events/activities.
Tick all that apply to you:

Get Ahead Career Experience Day
DairyNZ Career Day
DairyNZ Science Day
In2theField
Other career event – specify:

Please indicate which of the following influenced you to pursue a career in the dairy industry.
Tick all that apply to you:

Parents/family
School
Friends
DairyNZ Scholarship recipient
DairyNZ Graduate
Other– specify:

Please indicate how you found out about the DairyNZ Scholarship in the first instance.
Tick all that apply to you:

Parents/family
School
Friends
DairyNZ Scholarship recipient
DairyNZ Graduate
Websites
Other– specify:


Closing date for 2017 applications is 7 December 2016.

Signature: / Date:

Mail this completed application form and the supporting documents to:

Susan Stokes

Industry Education Facilitator

DairyNZ

Private Bag 3221

HAMILTON

Mobile: 027 702 1263

e-mail:

Selection Process

Applications are reviewed by DairyNZ. A short list of applicants will be drawn up after the initial review process is completed.

Applications for Lincoln University and Massey University are discussed by the Scholarship Selection Panel comprising representatives of DairyNZ, Lincoln University and Massey University and scholarships are awarded to successful applicants.

Applications for The University of Waikato are discussed by the Scholarship Selection Panel comprising representatives of DairyNZ and The University of Waikato and scholarships are awarded to successful applicants.

Successful applicants are contacted by phone and officially notified by email and post. Unsuccessful applicants are notified by email. All applicants will know the outcome of their applications by no later than 10 February.