Form No:
Effective Date:
Review Date:
Version:
EDU FOR-10
01/07/15
30/06/16
2.0
EDU FOR 10: EXPRESSION OF INTEREST – ASSOCIATE STUDENT MEMBERSHIP
This form is to be completed by a member organisation or external organisation (sponsored) to
nominate a student for consideration of a WaterRA Associate Student Membership.
The Associate Student Membership is an opportunity to introduce additional Summer, Honours,
Masters and PhD students to WaterRA and the benefits of being directly engaged with industry and
WaterRA members.
Cost (to be invoiced in January):
Member Sponsored application
External Sponsored application
$1500
$1700
Name
Email address
Phone number
Organisation
Is this EOI for a Summer,
Masters or PhD student?
Proposed student project
title
Brief Project Summary
Student name & email
address or tba if not
selected yet
Identify if student
academic transcript is
attached or to be
forwarded (approx. date)
University Summer
student Insurance
Certificate attached
(if applicable)
Brief background on the
student situation
Approx date the student
will commence (or has
commenced)
How does the Associate
EDU FOR-10 Expression of Interest – Associate Student Membership
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Form No:
Effective Date:
Review Date:
Version:
EDU FOR-10
01/07/15
30/06/16
2.0
Student Membership
benefit this student?
Additional information
Confirmation that the student will be available to attend the WaterRA events
16-19 February 2016 (Delete what does not apply)
Does your organisation wish to sponsor the Associate Student? (To be invoiced in
January) (Delete what does not apply)
Is this application for consideration of WaterRA sponsorship?
Yes/No
Yes/No
Yes/No
(Delete what does not apply)
WaterRA Due Diligence
Member Organisation
External Organisation
Satisfactory Student
Project relevance
Insurance Certificate
received (if required)
Application accepted for
WaterRA funding
Application accepted for
Member sponsored funding
Application accepted for
external sponsored funding
______________________________
Dr Paul Pretto
Date
WaterRA
Chief Executive Officer
EDU FOR-10 Expression of Interest – Associate Student Membership
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