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ULTRIS UNDERGRADUATE LEARNING AND TEACHING RESEARCH INTERNSHIP SCHEME

APPLICATION PROFORMA

2014

Please attach this form to your application and mail 3 copies to arrive no later than March 14, 2014, to:

ULTRIS Co-ordinator,

Centre for the Advancement of Teaching and Learning, M400

The University of Western Australia

35 Stirling Highway

Crawley WA 6009

APPLICANT'S DETAILS (to be completed by Undergraduate applicant)

Family Name: / Title (Mr/Mrs/Ms):
Given Names: / Student No: / Full-time:
Part-time:
Your Address: (correspondence will be posted to this address):
Phone No.
(Home): / Phone No.
(Mobile):
University Student Email Address only: / (e.g. )

Note: All correspondence and communications will be sent to this email address.

Did you attend the ULTRIS information session on 4 March 2014? / Yes / No
Do you currently have a job? / Yes / How many hours/week do you work?
No
Do you intend to undertake work in addition to your university studies between March and September 2014? / Yes / No

Will you be available to attend all workshops and Yes No

seminars from March to September, 2014

(see ULTRIS Guidelines 4.1 and 4.2)

Faculty:
If you are a combined degree student please list both faculties / Major/s:

Names of Referees:

·  Name and contact details (nominated Academic Referee - refer Guidelines 5.4):

School:

·  Name and contact details (nominated Academic Referee - refer Guidelines 5.4):

School:

I wish to apply for the ULTRIS. I have read the guidelines and understand that I must be available to attend the workshops and seminars from March to September, 2014.

Applicant’s Signature: / Date:

Head of School Endorsement

If you are a combined degree student and wish to be considered for the Internship in either Faculty you will need to get the signed approval of both Heads of School.

As Head of School I support this student’s application. I have been made aware of the requirements of the ULTRIS [See ULTRIS Guidelines] and believe this student to be a suitable candidate.

1. / HOS Name: / Signature:
School: / Date:
2. / HOS Name: / Signature:
School: / Date:


Checklist of Application Requirements

Attached

Three (3) copies of the following:
1. This Application Form (Attachment A) completed and signed by applicant and Head of School / [ ]
2. For students whose academic record to date is from UWA - a copy of the official transcript of academic record.
For students with non-UWA academic record - a certified copy of the official transcript of academic record (and translation if required).(further information relating to UWA’s policy for certifying documents can be found at the following website; www.admissions.uwa.edu.au/page/89777) / [ ]
3. A statement in response to the two selection questions (refer to clause 5.4 of Guidelines). / [ ]
o  What are your reasons for wanting to participate in the ULTRIS?
o  What is your understanding of research in general, and teaching and learning research in particular?

Completed applications should be forwarded no later than March 14, 2014 to:

Address Details

ULTRIS Co-ordinator,

Centre for the Advancement of Teaching and Learning, M400

The University of Western Australia

35 Stirling Highway

Crawley WA 6009