Application Form


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NameApplication Form
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WOOL RESEARCH ORGANISATION OF NEW ZEALAND INC AND NEW ZEALAND WOOL INDUSTRY CHARITABLE TRUST POST DOCTORAL FELLOWSHIPS

Application Form




Prior to completing this application, the Scholar should read the information relating to the detail of, and eligibility for a Fellowship contained in the Wool Education Portfolio section of the Wool Research website: www.woolresearch.com


PART A


Section One: Contact Details and Proposal Summary


  1. Fellow and Host Institution Details


Host Institution


Host Institution

Fellow

Institution name




Name




Address




Address




Contract Liaison contact




Email




Email




Phone




Phone










Financial Liaison contact




Mentor




Email




Job Title




Phone




Email










Phone






  1. Short Title of Research Proposal



  1. Summary of Research Proposal



Section Two: Student and Qualification Details


  1. Personal Details




Date of Birth:




Nationality




Gender:




NZ Citizen







  1. Academic Assessment


Fellow: Attach a certified copy to Part B of the application of

  • your academic transcript

  • confirmation of your Doctorate



  1. Confirmed Academic Qualifications




Certificates, Diplomas,

Degrees or equivalent

Supervisor

Institution/Organisation


Year Confirmed



























  1. Awards, prizes or scholarships you have received and/or are still receiving




Award

Start/End Date

$ Value






























  1. Research History




1

Host Organisation








Period of Research






Purpose of Research








Topic of Research










2

Host Organisation








Period of Research






Purpose of Research








Topic of Research






  1. Outcomes from Research Experience


  1. Publications



  1. Work History




Employer

Job Title


Start/End Dates






























  1. Start Date and Research Area




Indicative start date:




Research Area





Section Three: Research Proposal


  1. Purpose/Proposed Outcomes




  1. Specific Objectives/Aims of the Project




  1. Ability to deliver the research

3.1 Facilities and Equipment

3.2 Linkages and Collaborations

3.3 Research Group Status and Experience

3.4 Mentor Status and Experience

  1. Milestones and Expected Timelines

Indicative Start Date







Milestone Number

Milestone

Milestone Due Date








































  1. Research Methodology




  1. Knowledge Transfer




  1. Ethical and/or Regulatory Approvals (where appropriate)

Section Four: Host Institution Support
Curriculum Vitae Of Mentor/Supervisor
(Maximum of two pages)
Leave blank at this stage if applying from overseasor and not yet arranged a Supervisor



  1. Curriculum Vitae




Name:










(Surname)

(First Names)




Present position:







Present Employer:







Present Work Address (if different from Host Institution):


















Academic qualifications:

(including year awarded):

















Years as a practising researcher:
Honours/distinctions/membership of societies, institutions, committees:

(include both academic and end-user involvement)
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
Professional positions held: (years, position, institution, activity)
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Present research/professional speciality:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Number of refereed publications: 

Number of patents: 

Number of significant publications not included in the above: 
Number of research qualifications at Level 7 NQF/Hons supervised to completion: 

Number of post-graduate theses supervised to completion: PhD:  Masters: 

Number of post-graduate theses examined: PhD:  Masters: 

List of major achievements pertinent to the supervision of this research proposal:

Use the following subheadings:


    1. Major publications (in the last five years)


………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………



    1. Major achievements in commercial, social and environmental areas (including evidence of relationship management, business, commercial and project management expertise, if relevant).


………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………


    1. Demonstration of relationships with end-users.


………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Section Six: Referees



Please list below the names of your two referees and their organisations (this is for internal reference only and the Manager does not undertake to follow up on reports not received).


Name




Organisation




Address




Phone




Email










Name




Organisation




Address




Phone




Email





Section Seven: Information on Fellowships





How did you learn of this scheme?

  • delete those that don’t apply

  • identify the name of a particular organisation or person if possible

Colleagues

Proposed Host Organisation

Newspaper ad/article – which?

Science Journal

Internet - who

University - which

Research Institute - which

Other - detail


PART B

Signatories
We, the undersigned, agree:


  • That to the best of our knowledge all information provided on this Application Form is true and correct;

  • That the Wool Research Organisation of New Zealand Inc And New Zealand Wool Industry Charitable Trust Post Doctoral Fellowships Description document for applicants have been read and accepted;

  • To the programme stated in this Application, together with our respective obligations and responsibilities to each other;

  • That all ethical and/or regulatory approvals for the research programme have been obtained, where necessary;

  • That issues of Intellectual Property and ownership have been discussed with the parties including the Manager of the fellowship programme;

  • That the Manager of the Fellowship programme may use and store information provided in this application according to the principles of the Privacy Act 1993 (to be used for administrative purposes only);

  • That it is the responsibility of the applicant, if not the holder of New Zealand residence status, to organise matters relating to immigration, visas and travel arrangements before applying to ensure they are eligible to undertake the study programme.

  • That the Manager may publish information about the Fellow on relevant websites and in other promotional material for the purpose of advertising and promoting Fellowships and career promotion opportunities in the New Zealand wool industry.

  • That no fellowship will be awarded until a contract between the applicant and other relevant parties has been agreed and signed. An example of the contract content is obtainable from the Manager of the fellowship programme



Fellow Applicant:
Name:
Signature: __________________________ Date:

Mentor/Supervisor to Fellow:
Name:
Appointment Held:
Signature: Date:
Host Institution Director (or nominee):
Name:
Position Held:
Signature: __________________________ Date:

Mail this completed application form to:
Ian Cuthbertson

Research & Scholarships Manager

Wool Research Organisation of New Zealand Inc and

New Zealand Wool Industry Charitable Trust Scholarship Programme

PO Box 27-277

The Palms, Shirley

Christchurch, New Zealand
Phone: 64 3 3372030

Fax: 64 3 9609802

e-mail: scholarships@woolresearch.com

Applications close on 17 September, 2010. Advice on the outcome of the application should be known by 1 November 2010.

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