Opportunity for Undergraduate Students

APRU Undergraduate Leaders Program

INSPIRE: Next Generation of Innovators

Tec de Monterrey, Mexico

3-13 July 2016

Application Form

This opportunity is for selected students enrolled at the University of Auckland to participate in the Association of Pacific Rim Universities’ Undergraduate Leaders Program, hosted in 2016 at Tec de Monterrey in Mexico.

The University of Auckland will provide economy airfaresforselected students between Auckland and the event location.The University of Auckland will also cover the USD 500 registration fee for this event, which includes shared accommodation and some meals. Selected students will responsible for all other costs associated with attending the programme. For details about the travel grant coverage, please visit

The deadline for submission of this application is 12 noon on 31 March 2016.

Section A: CANDIDATE INFORMATION
Surname / Click here to enter text. /
Legal given names / Click here to enter text. /
Student ID number / Click here to enter text. /
Email address / Click here to enter text. /
Contact phone / Click here to enter text. /
Faculty/Faculties / Click here to enter text. /
Department/s / Click here to enter text. /
Programme of study (e.g. BSc) / Click here to enter text. /
Section B: SUPPORTING DOCUMENTATION CHECKLIST
☐ Copy of academic transcript (unofficial is acceptable)

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Section C: STATEMENT OF SUPPORT FROM HEAD OF DEPARTMENT, ACADEMIC SUPERVISOR OR EQUIVALENT
Please note that statements of support may alternatively be emailed directly by the staff member to from a University account by the application deadline.
Supervisor Name:Click here to enter text.
Faculty: Click here to enter text.
Comments: Click here to enter text.
Signature:

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Section D: CANDIDATE RESPONSES (max. 250 words each)

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Q1: What is your motivation for applying to this programme?
Click here to enter text.
Q2: How do you envisage that your participation in this programme will benefit your academic and personal development?
Click here to enter text.
Q3: Please provide an example of any previous experience you have had engaging with students from other academic disciplines.
Click here to enter text.
Q6: Please explain why you would be an excellent representative of the University of Auckland if selected.
Click here to enter text.
Q7: Please include any other information that you feel would strengthen your proposal.
Click here to enter text.

TERMS AND CONDITIONS

The following conditions must be adhered to as a representative of the University of Auckland while on a U21, WUN or APRU programme. These are to ensure that your experience overseas is enjoyable and that the integrity of the programme is maintained. Please read carefully.

If I am selected for one of these programmes I agree:

  1. To abide by all rules, regulations, policies, laws and reasonable requirements of both the University of Auckland and the host institution while attending the programme.
  2. That I will be liable for all costs associated with attending the programme, excluding those that the University of Auckland or the host institution has agreed to cover. (These may include, but are not limited to, visas, meals, activities, accommodation, local transport and airport transfers).
  1. To make arrangements for any additional travel and health insurance required for the duration of my trip.
  1. To act as a representative of the University of Auckland.
  2. That if I am subsequently charged with a criminal offence or am subject to disciplinary action under the Disciplinary Statute in the University of Auckland Calendar,to bring this to the attention of the Auckland Abroad Office immediately and also that my application may be terminated.
  3. That if I am successful in my application and it is subsequently discovered that information I have provided is not complete, accurate and correct or I have failed to disclose information, my application may be terminated.

I understand that failing to comply with any of the above conditions can result in my programme being terminated.

I agree to these Terms and Conditions: ☐

APPLICATION SUBMISSION

Please email the completed form to , and remember to attach your supporting documentation.

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