DEPARTMENT OF MATHEMATICS AND STATISTICS
DOCTORAL SCHOLARSHIPS
APPLICATION FORM
Applications close at 12 noon on 10th October 2011:
Department of Mathematics and Statistics
Level 4, Mathematics, Statistics and Computer Science Building
University of Canterbury
Private Bag 4800
CHRISTCHURCH 8140
For further enquiries contact:
douglas.bridges@math.canterbury.ac.nz
+64 3 364 2600
INSTRUCTIONS AND CHECKLIST
All applicants must

Print a hardcopy of the application form.

Read the regulations at the end of the application form.

Complete Section I (Applicant’s Details) of the application form.

Complete Section II (Research Proposal) of the application form in consultation with your senior
supervisor.

Provide a curriculum vitae.

Attach copies of ALL your academic transcripts and diplomas. If these are not from the University of
Canterbury, they must be certified copies.

Give the application form and all required supporting documents to your senior supervisor.
Applicants with tertiary qualifications gained outside New Zealand must

Apply for, or have been granted, admission ad eundem statum. Provide evidence of application or
admission.

Attach two academic references.
Senior supervisor must

Read the regulations at the end of the application form.

Complete Section III (Senior Supervisor’s Report) of the application form.

Check that application is complete with all the required supporting documents.

Submit the completed application, on behalf of the applicant, to the Department Office before the closing
date.
________________________________________________________________
DEPARTMENT OF MATHEMATICS AND STATISTICS
DOCTORAL SCHOLARSHIPS
PART I: APPLICANT’S DETAILS
CONTACT DETAILS
Full name:
.........................................................................................................
University of Canterbury Student ID. : ....................................................................................
Street address:
Suburb: .........................
Country: .........................
Telephone: .........................
Town/City: ..................................................
Cell phone: ................................................
Email: (UoC) : .................................................
(Personal): .................................................
PREVIOUS STUDY AT ANOTHER TERTIARY INSTITUTION
If you have undertaken study at another tertiary institution, please attach certified copies of your academic
transcripts and diplomas.
If your previous tertiary qualifications were gained outside New Zealand, please also provide two written
academic references. Note that you must have applied for, or have been granted, admission ad eundem
statum at the time of making this application.
If you are currently enrolled at another tertiary institution,
indicate the date when a final result is expected:
List any academic prizes or distinctions received at another tertiary institution:
_______________________________________________________________________________________
_______________________________________________________________________________________
List the titles of any publications or theses submitted for any degree at another tertiary institution:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
________________________________________________________________
Full Name: ..................................................
FUNDING DETAILS
Give details of all scholarships that you have been awarded for this degree:
Name of scholarship
Period of award
Stipend amount
Pays fees?
(Yes/No)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Give details of all scholarships that you have applied for, whose outcomes are pending:
Name of scholarship
Date result is expected
Stipend amount
Pays fees?
(Yes/No)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Are you willing to do some part-time tutoring or marking for the Department?
________________________________________________________________
INTERNATIONAL STUDENTS
If you are an international student, provide your country
of citizenship or permanent residence:
________________________________________________________________
PRIVACY PROVISIONS
The information requested in this application form will be used solely for the purposes of assessing your
application for the Scholarship for which you are applying. Personal information contained in this application
will be made available only to members of the appropriate selection committee.
Should you have reason to believe that information about you, supplied in connection with this application, or
in your academic record, is incorrect, you have right of access to, and where appropriate, correction of, that
information.
Where references are required and are sent direct to the Department by the referee or given to the student in a
sealed envelope to be attached to the application, the references will be considered confidential and will not be
released to the student without the written authorisation of the referee.
DECLARATION:
I have read and understand the regulations for the above award and the privacy provisions and I agree to abide
by them, and should I be successful with this application, agree to take part in any publicity that may arise from
the award.
Signature: ______________________________________
Date: ____________________
DEPARTMENT OF MATHEMATICS AND STATISTICS
DOCTORAL SCHOLARSHIPS
PART II: RESEARCH PROPOSAL
Full name of applicant:
Programme:
Degree:
Senior supervisor:
Title of topic:
List any employment positions currently or previously held relevant to proposed research
Signature: _________________________________________
Date:
________________________________________________________________
SUMMARY OF PROPOSED RESEARCH
Please attach a one-page summary of your research proposal. It is expected that you would have discussed your
research with your senior supervisor prior to submitting this application .
DEPARTMENT OF MATHEMATICS AND STATISTICS
DOCTORAL SCHOLARSHIPS
PART III: SENIOR SUPERVISOR’S REPORT
(CONFIDENTIAL)
Full name of applicant:
This report is confidential. Please provide comments below and submit the application, on the applicant’s behalf,
directly to the Department Office by the closing date.
________________________________________________________________
For new Doctoral student:
1. Comment on the adequacy of the applicant’s previous training, academic ability and research experience for the
proposed research:
2. Provide your opinion on the applicant’s research potential by circling one of the five options given:
(a)
(b)
(c)
(d)
(e)
Insufficient evidence to comment
Very little potential
Capable of producing a satisfactory thesis within 3 years
Capable of producing a high standard thesis within 3 years
Capable of producing an outstanding thesis within 3 years
3. For applicants with qualifications gained outside University of Canterbury only (leave blank if unable to estimate):
(a)
Estimated GPA for the applicant:
(b)
Basis for estimation:
4. Any other comments.
For continuing Doctoral student:
1. Comment on the applicant’s progress in his/her research:
2. Comment on the applicant’s likelihood of completing and by when:
3. Any other comments:
Please indicate whether you strongly support / support / do not support this application.
Senior Supervisor
Signature ……………………………..……….
Date …………………