MENZIES SCHOLARSHIPS TO HARVARD APPLICATION FORM Sponsored by the Harvard Club of Australia and the Australian National University. Application Form for the 2017/18 Menzies Scholarships (for study commencing in mid-2018) Applications must be sent to: philanthropic.scholarships@anu.edu.au by 5pm Thursday 9 February 2018. Applications should be emailed as one PDF document. Please type your application in Times New Roman 12 point font. The primary criteria considered for the Menzies Scholarships are qualities of intellect, leadership and vision for your contribution to the Australian community. Evidence of these qualities is essential to your application and successful candidates in the past have taken care to provide sufficient information on their background, interests and aspirations to convey an idea of their suitability for the Menzies Scholarships. Contact Details Title, Family Name: Other Names: Home Address: & Postal Address (if different): Work/Daytime: Home: Mobile: Date of Birth: Place of Birth: Citizenship: Application Form Menzies Scholarships to Harvard for 2017/18 1
Harvard University Details What is the status of your application to Harvard? Which Harvard Graduate School have you applied to? What course/degree have you applied for? In what area will you specialise? Accepted/Pending (If accepted, please provide a copy of your letter of offer) When do you propose to commence study? Academic Qualifications Please attach your official academic transcript/s giving complete details of your tertiary studies for all courses completed and/or in progress. Degrees/Diplomas Awarded Institution Year/s Grade Courses in Progress Institution Year/s Result Due Please list your publications, awards, scholarships and other academic achievements. Titles of Publications, Papers and Theses Submitted: Memberships, Distinctions, Awards and Prizes: Application Form Menzies Scholarships to Harvard for 2017/18 2
Scholarships Held (past and present): Please detail any scholarships you have applied for, the value and tenure. Other Academic Achievements: Employment (Present & Past) Please include any research work or experience relevant to your proposed course. Name and Location of Employer Position Held Date of Employment Application Form Menzies Scholarships to Harvard for 2017/18 3
Extra-Curricular Activities Please list your extra-curricular activities, including community or volunteer work and the leadership roles that you have held or currently hold and the relevant dates. Statement of Purpose Please attach a statement of no more than two typed A4 pages. Your Statement of Purpose should include relevant details of your background (including community and recreational interests and, if relevant, career to date), your personal philosophy, your aspirations and future career plans, and how you believe you can contribute to the future interests of Australia. Referees Please provide the names and contact details for three referees. Two of your referees must be qualified to speak with knowledge of your academic and/or professional merit and capacity for higher degree study. One referee must be able to write a personal reference, commenting on your personal qualities and role in the wider community. Please note that only short-listed candidates will be required to ask their referees to submit a reference and they will be advised of this by the end of February. (Referees will need to be able to submit their reference by Monday 26 March 2018). Application Form Menzies Scholarships to Harvard for 2017/18 4
1 Title and Full Name of Referee: Position held: Organisation/Institution: Mailing Address: Area (s) of work with which the referee is familiar: 2 Title and Full Name of Referee: Position held: Organisation/Institution: Mailing Address: Area (s) of work with which the referee is familiar: 3 Title and Full Name of Referee: Position held: Organisation/Institution: Mailing Address: Area (s) of work with which the referee is familiar: Future Career Please write up to 250 words on what you plan to do after you graduate from Harvard? Application Form Menzies Scholarships to Harvard for 2017/18 5
Financial Details Please outline your budget for the entire period of your studies at Harvard (including your travel). Provide details of all confirmed scholarships and other financial support (including offers of corporate/employer sponsorship) and any other funding applications and scholarships that may be pending approval, showing fallback alternatives. Would your partner and/or children accompany you? Additional Information How did you become aware of the Menzies Scholarships? Internet: Newspaper Advertisement: University Advertising (eg. noticeboards, flyers, campus publications): Other (please provide details): Signature I declare that the information supplied for this Menzies Scholarship application is, to the best of my knowledge, complete and correct. I will notify the Scholarship Administrator as soon as possible, if and when any details provided change, including if I am awarded funding from another source. Signature Date Application Form Menzies Scholarships to Harvard for 2017/18 6