PACIFIC SHORT TERM TRAINING SCHOLARSHIPS

Application form for PACIFIC SHORT TERM TRAINING SCHOLARSHIPS OFFICE USE ONLY Applicant name: Country: Date:

SHORT TERM TRAINING SCHOLARSHIPS (STTS) Short Term Training Scholarships assist people in the work force to gain knowledge and skills that will help the development of their home country. They play a role in addressing the human resource and development needs of developing countries. CHECKLIST It is important that you correctly fill out all relevant sections in the application form and include all documents listed below. Incomplete forms can cause delays with your application and may also lead to the application missing the application deadline. Applications with incomplete documentation will not be considered for a scholarship. Documents attached to this application must be certified true copies of originals with the official stamp of the school/institution where relevant or from a Justice of the Peace, Solicitor, Notary Public or official from the institution or other authorised official. Where original documents are not in English, you must provide certified true copies of official English translations. Ensure that your completed application form includes: Completed eligibility checklist Signed and completed declaration Certified copy of your birth certificate (in English) A certified copy of the personal pages of your passport Recent passport photograph Certified academic transcript (in English) of all school results (where applicable) and tertiary results, including the grade assessment schedule used at each institution Certified copy of the completion or graduation certificate (in English) for each tertiary qualification that you have completed (Where required) original International English proficiency test results e.g. IELTS or TOEFL (copies will not be accepted). Test results must be no more than 24 months old Copy of any correspondence with an education institution or training provider, related to your application Current job description stating your position and outlining your responsibilities and duties, if you are employed Current curriculum vitae - a brief and current history of your education and job skills and experiences Important note: Photocopies of documents that are included with each application will need to be CERTIFIED true copies of the original document. FURTHER INFORMATION Information on the Short Term Training Scholarships, including eligible countries, the application process, deadlines is available at: http://www.mfat.govt.nz/scholarships SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 2

SECTION ONE: Eligibility Criteria Check List To be eligible for a New Zealand Scholarship, you must meet the YES NO Not following criteria. If you are not eligible, please do not complete Applicable the rest of the application form. 1. I will be at least 18 years old at the time I start the scholarship. 2. I am a citizen of a participating country and I am residing in and applying for a scholarship from my country of citizenship. 3. I am not also a citizen or permanent resident of any the following countries: New Zealand 1, Australia, Israel, South Korea, Japan, USA, any European Union country, Qatar, United Kingdom, Canada, Saudi Arabia and the United Arab Emirates. 4. My country has been my main country of residence for the last two years or more (unless you are a member of the diplomatic corps or a dependent of a member of the diplomatic corps). 5. I confirm that I am not currently serving in the military. 6. I want to study at a level that is available for the country for the scholarship. 7. I expect to meet Immigration requirements for a student visa to New Zealand (i.e. medical checks, etc.). Check Immigration New Zealand website. 8. I expect to meet the academic entry requirements (including English language ability) for my preferred programme of study and institution. 9. I confirm that I have not previously had a New Zealand Scholarship terminated because of poor academic performance (within the past 5 years) or breach of scholarship contract. 10. I can demonstrate that the study I want to do will enable me to contribute to the sustainable development of my home country. 11. I am committed to return to my country for a minimum of two years after completing my scholarship of more than six months long to contribute to my country s development. 12. I do not hold, or have not held, any New Zealand Government tertiary scholarship in the preceding two years at the time of application (unless prior approval is granted by MFAT). 13. I do not hold, or have not held, a New Zealand Government-funded scholarship of less than six months long, including: Short Term Training Scholarship (STTS), English Language Training for Officials (ELTO) or in-country vocational training, in the last 12 months at the time of application. 14. I have at least one year full time (two-year s part time) work experience relevant to my career. 15. I am currently employed in the proposed field of study and have the endorsement of my employer for the proposed field of study. 1 This does not apply to applicants from Niue or applicants from Samoa with dual Samoa-NZ citizenship. SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 3

SECTION TWO: SHORT TERM TRAINING SCHOLARSHIPS DECLARATION Conditions of Scholarship If your application is successful and you are offered a Short Term Training Scholarship, you will be asked to sign a declaration which confirms that you understand and agree to certain conditions before accepting the scholarship. In accepting, you will be asked to: agree to undertake my approved course of study full time and comply with the regulations of the training/education provider and MFAT s Short Term Training Scholarships conditions; agree to make every effort to achieve satisfactory progress in my training programme in accordance with the training objectives and standards set by the New Zealand Aid Programme and the training/education provider; agree to accept no paid employment while in New Zealand except where it is an agreed component of my training programme; agree to assist with the monitoring and evaluation of the scholarship scheme while on scholarship or following completion of my scholarship; agree to ensure my immigration visa and passport are kept current for the duration of my study or training; agree return to my home country of residence within fourteen days of the final completion date of my scholarship; agree to notify the organisation administering my scholarship of any change in circumstances which may affect my ability to continue with or complete my training programme within the time allowed for the scholarship; agree to the study programme included in the Letter of Scholarship Offer and the fact that this must not be changed without the prior written approval of MFAT; agree to obey the laws of New Zealand and maintain an acceptable standard of conduct while in New Zealand; agree that the New Zealand Government is not responsible for any of your actions during the term of your scholarship; agree that you will not apply for permanent residency of any country including New Zealand during the scholarship period or within two years of scholarship completion or within one year after completing a scholarship of six months or less; agree that you and your spouse/partner and dependant children (if relevant) will leave New Zealand within 14 days of completion of your training programme. You will return directly to your home country for a minimum period of two years if your scholarship is more than six months long, in order to utilise the knowledge you have gained through your scholarship to contribute toward the social and/or economic development of my home country; agree that you and your spouse/partner and dependant children (if relevant) will not apply for a visa (excluding a short term visitor visa) to re-enter New Zealand within two years of scholarship completion or for a minimum period of one year if you study in New Zealand for six months or less. SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 4

Declaration I understand that: 1. This scholarship may be administered through an organisation contracted to the Ministry of Foreign Affairs and Trade s New Zealand Aid Programme and that any requests for information or advice about this scholarship should be directed to that organisation in the first instance. 2. That the law of New Zealand will apply to any agreement between myself and the New Zealand Government. I confirm and declare that: 1. I agree to the release of information in this application form and information relating to the scholarship or study to relevant authorities, in accordance with the New Zealand Privacy Act 1993, to enable placement in an education institution, consideration for a scholarship, collection of academic progress reports and results, and the ongoing administration and monitoring of the scholarship; 2. I agree to the exchange of information between MFAT and authorities such as Immigration New Zealand (regarding your immigration status) or any other relevant government agency (e.g. New Zealand Inland Revenue or the New Zealand Qualifications Authority); 3. I am not aware of any medical, personal or other circumstances (e.g. disability, illness, family or financial matters), which might prevent me from completing my study within the scholarship term; 4. Information provided about and by me in the eligibility and application form is true, complete and correct to the best of my knowledge. 5. I acknowledge that supplying false or misleading information is a serious offence under the New Zealand Crimes Act 1961 and will result in the New Zealand Ministry of Foreign Affairs and Trade (MFAT) withdrawing a scholarship, if offered. Full Name Signature Date dd/mm/yyyy SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 5

SECTION THREE: PERSONAL INFORMATION Please note that your family name and other names should be the same as the official names in your passport or birth certificate. First name(s) Family name (surname) Gender Male Female Attach a recent passport sized photograph of yourself Date of birth Place of birth Country of citizenship 2 nd country of citizenship Do you have permanent residency status in any other country? Have you applied for permanent residency status in any other country? (dd/mm/yyyy) Yes No If yes, please list: Yes No If yes, please list: Please list second country if you have dual citizenship Passport number Passport expiry Do you suffer from any illness or disability that might affect your ability to participate in the proposed study programme (for example, psychiatric condition, asthma, diabetes, significant visual impairment, motor disability or significant hearing loss)? A Yes answer will not affect your chances of successfully obtaining a scholarship. Yes No If you have answered Yes, please provide brief details of the illness or disability and any special requirements or support you may require to complete your study programme on a separate sheet of paper. Please attach a copy of your doctor s assessment of your needs. Applicant contact details: The scholarship application process takes several months. Please give an address where you can be contacted when a decision is reached. You may not be offered a scholarship if you cannot be contacted. Number and street name PO Box number Suburb/village Town/city District/Province Country Post code SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 6

Home telephone number Work and/or cell-phone number Email address (enter more than one if relevant) Emergency contact details: Name someone we can contact in an emergency Name Relationship to you Number and street name Suburb/village Town/city Country and post code Home telephone number Work and/or cellphone number Email address SECTION FOUR: STUDY HISTORY You must provide a certified copy of the academic transcript and completion certificate for each qualification you have completed/are completing. You must also include a certified copy of the grade assessment schedule for each qualification. Provide the following information for all completed and partially completed and partially completed secondary, vocational or tertiary qualifications. List the most recently completed qualification first. Qualification Major subject Education institution Institution location Start date Qualification Major subject Education institution Institution location Start date End date End date SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 7

Qualification Major subject Education institution Institution location Start date Qualification Major subject Education institution Institution location Start date Qualification Major subject Education institution Institution location Start date End date End date End date List any of the qualifications that have been studied by distance education List details of any relevant academic distinction or prizes List any scholarships you have previously received funded by the New Zealand Government. Include the name and duration of the scholarship/s, the qualification or course undertaken, and the date completed. SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 8

SECTION FIVE: CURRENT STUDY/WORK List your current occupation (if working or not studying or working is selected, go to Section Four) Working (full-time) Working (full-time) and studying at tertiary level (fulltime) Studying at secondary school Working (full-time) and studying at tertiary level (part-time) Studying at tertiary level Not studying or working If you are studying now, list the level at which you are studying Secondary school Undergraduate diploma Masters degree University foundation year Bachelors degree Doctorate (PhD) Tertiary training / technical certificate Postgraduate diploma Other Qualification name Major subject(s) Start date Proposed end date Length of qualification Education institution name Institution location (town/city and country) Are you on a scholarship now? If yes, complete details below Yes No Sponsor name Scholarship name SECTION SIX: WORK HISTORY This section covers your work history and current work situation. If you are: Currently employed or have recently been employed: Answer the questions in this section; and Provide an up-to-date curriculum vitae and current job description with this application. Not currently employed and have no previous work experience: Go to Section Five. Current position title Organisation Start date SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 9

If you are employed now, tick one box that is most similar to your area of work identify one employment sector most similar to your current area of work list below. Employment sector Agriculture (including agribusiness & animal health) Business (private sector) Diplomacy / Foreign Affairs Disaster Risk Management Education Primary/Secondary Education Tertiary Economics and Finance Engineering Environmental/Natural Resource Management Fisheries/Marine Resources Food Safety Forestry Health Information Technology Public Sector Management /Governance Public Utilities and Infrastructure Renewable Energy Skilled Trades (plumbing, electrical, construction) Tourism Trade Urban Planning and Development Waste Management Other (please state) What type of organisation do you work for? Local Government Central Government Community/Non- Government Organisation International NGO Private company Self-employed Multilateral Agency Other (please state): Briefly describe the work of your organisation. Will you return to your current job after your study? Yes No If you answered no or you are not currently working, what is your prospective employment on your return home? Name of Job Organisation Attach an up-to-date curriculum vitae and current job description to this application form SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 10

SECTION SEVEN: PREVIOUS TRAINING Please provide details of the last two training courses you attended in your country or in another country. List your most recent training course first. Name of training course/qualification: Institution/organisation: Country: Start date Who funded this training: Self-funded or family funded End date Home government New Zealand government/ New Zealand Aid Programme Another government Church or community International organistaion Other (please specify): Name of training course/qualification: Institution/organisation: Country: Start date Who funded this training: Self-funded or family funded End date Home government New Zealand government/ New Zealand Aid Programme Another government Church or community International organistaion Other (please specify): SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 11

SECTION EIGHT: ENGLISH LANGUAGE COMPETENCY You may be required to meet the English language proficiency criteria for admission to the institution where your training will take place. If required, please attach original copies of your test results to this application form. Test results must be no more than 24 months old. Yes No Is English your first language? If you answered No, please complete this section. If you answered Yes, please go to Section Seven. Have you been taught in the medium of English? Yes No If yes, tick the boxes at the level you have been taught in English Primary school Undergraduate or postgraduate level Junior secondary/high school While training for my job Senior secondary/ high school Other: Please state: Include details below of any IELTS (International English Language Testing System) academic tests you have undertaken. Please also attach the original copy of the results to this application form. IELTS date of test IELTS listening band IELTS writing band IELTS overall score IELTS reading band IELTS speaking band Include details TOEFL (Test of English as a Foreign Language) test you have undertaken. This should be EITHER an Internet-based TOEFL score OR a Paper-based TOEFL score. Please also attach the original copy of the results to this application form. Test of Written TOEFL date of test English (TWE) score Internet-based TOEFL Paper-based TOEFL score score If you have completed an IELTS/TOEFL test but are waiting for results, please send the results when available. Date results available: SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 12

SECTION NINE: PROPOSED STUDY PROGRAMME Please specify preferred training programme or the type of training you require: Name the institution/ training provider where you would like to undertake your training (if known). What is the proposed length of the short term training? What are the learning outcomes you hope to achieve from your training? Please include a description of any particular skills and knowledge you and your organisation want to gain from your training. Please be as specific as possible. Outcome: Outcome: Outcome: Outcome: If you were to be successful in your application for a STTS how would the benefits of the training: a) enhance the development project, programme or process your organisation is engaged in: SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 13

b) be able to benefit others in your organisation and the country you are working in Please indicate the area of work you will return to on completion of your training. a) Agriculture (including agribusiness & animal health) b) Business (private sector) c) Diplomacy / Foreign Affairs d) Disaster Risk Management e) Education Primary/Secondary f) Education Tertiary g) Economics and Finance h) Engineering i) Environmental/Natural Resource Management j) Fisheries/Marine Resources k) Food Safety l) Forestry m) Health n) Information Technology o) Public Sector Management /Governance p) Public Utilities and Infrastructure q) Renewable Energy r) Skilled Trades (plumbing, electrical, construction) s) Tourism t) Trade u) Urban Planning and Development v) Waste Management e) Other If you are not returning to your current job on completion of your scholarship, please explain why: SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 14

SECTION TEN: EMPLOYER INFORMATION If you are working, this section must be completed (in English) by your employer. If you are selfemployed, you may answer the questions yourself. Organisation name Address Telephone Number Email address Do you confirm that the details provided in Sections Six and Seven of this application are accurate, and do you support the applicant s application for a Short Term Training Scholarship in New Zealand? Yes No Is there any person in your workplace who has undertaken this training before? If yes, please give details (names, dates, year training took place, location of training) Yes No Are there any other comments you would like to make in support of this application? Authorising official s full name Position Signature Official Stamp Date (dd/mm/yyyy) SHORT TERM TRAINING SCHOLARSHIPS APPLICATION FORM 15