Application Form Page 1

Student Surname..

Student ID No

Resource Management Law Association of New Zealand Inc. (RMLA)

Masters Scholarship

Document Checklist

Document Tick when attached

RMLA Application Form pages 1-3

RMLA Privacy Form

Certified Copy of:

current New Zealand passport; or
proof of New Zealand citizenship; or
proof of New Zealand permanent residency.
Certified Copy of Academic Record

Statement Outlining Proposed Course of Study

Outline of Proposed Thesis/Dissertation and Name of your Supervisor

Extra pages for section

Written Recommendation from Supervisor (Optional)

Please Note: You must correctly fill out the application form and include all documents listed
above. Incomplete applications will not be considered.

Office Use Only

Date Recd Complete Acknowledge Receipt Forward RMLA Scholarship

Selection Committee
 Application Form Page 2

Student Surname..

Student ID No

Resource Management Law Association of New Zealand Inc. (RMLA)

Masters Scholarship

___________________________________________________________________________
PERSONAL DETAILS

NAME IN FULL: Ms/Miss/Mrs/Mr/Dr..............................................................................................

.......................................................................................................................................................
.......................................................................................................................................................

Term Address...................................................... Permanent Address..........................................

............................................................................. ........................................................................
............................................................................. ........................................................................
............................................................................. ........................................................................

Telephone: ( ) ................................................... Telephone: ( ) ...............................................

Email Address:.......................................................Mobile No: .....................................................

ARE YOU A NEW ZEALAND CITIZEN? (Please circle one)

Yes No

ARE YOU A PERMANENT RESIDENT OF NEW ZEALAND? (Please circle one)

Yes No
___________________________________________________________________________

REFEREES

List the name and address of your referee(s) below. These people must fill in the attached form which
must be sent with this application to the RMLA by 1 August.

Name: ..........................................................................................................................................
Address: .......................................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
___________________________________________________________________________

DECLARATION

I have read and understood the rules for the RMLA Masters Scholarship and agree to abide by them.

Date:..............................................................Signature: ..............................................................
 Application Form Page 3

Student Surname..

Student ID No

ACADEMIC RECORD

Please attach a certified copy of your academic record.

TERTIARY EDUCATION RECORD

Institution Place and Country Years Attended Degrees, Diplomas

From To or Certificates gained

PROPOSED COURSE OF STUDY

Attach a statement detailing your proposed research. This shall include an outline of the methods of
investigation you propose to adopt and a list of publications, if applicable.

TITLES OF MASTERS RESEARCH (IF KNOWN)

...............................................................................................................................................
...............................................................................................................................................

INTENDED STUDY
University..........................................................................

Department.............................................................................................................

Degree..................................................................................................................

SCHOLARSHIPS/PRIZES

List Scholarships/Prizes you have applied for this year:

................................................................................................................................................
................................................................................................................................................

List Scholarships/Prizes you have received to date:

 Application Form Referees Report

Student Surname..

Student ID No

REFEREES REPORT

Applicants Name: ...............................................................................................................................

Student ID Number: .............................................................................................................................

Please provide an academic reference on this form (you can attach extra pages if required), for
the above student. This reference will be only be used to determine the applicants eligibility for
the scholarship.

Send this report to: RMLA Scholarship Selection Committee

RMLA
PO Box 89187
Torbay
Auckland 0742

This report must be received by the RMLA Scholarship Selection Committee by 1 August.

_____________________________________________________________________________

Referees Name: (Pls Print).............................................................................................................

University/Dept: ...............................................................................................................................

Signature: ..........................................................................Date: .....................................................

 Application Form Privacy Form

Student Surname..

Student ID No

RMLA PRIVACY FORM

The information requested in this application and your academic record will only be used for the purposes
of assessing your application for the Scholarship for which you are applying. Personal information
contained in this application will only be made available to members of the RMLA Scholarship Selection
Committee. The Committee will use the reference from the person designated by you, in assessing your
application.

The RMLA Scholarship Selection Committee may also contact your referee directly to ask further
questions and discuss your application.

The RMLA undertakes to store your application in a secure place if:

you are successful in gaining an award; or
you are selected as a reserve candidate for an award.

The RMLA undertakes to destroy your application in the event that you are unsuccessful.

If you believe that information held about you in either your application or your academic record is
incorrect, you have the right to access and correct that information.

Applicants agree to the RMLA obtaining their academic results from any organisation, such as NZQA,
necessary to assess their application.

Applicants shall agree to co-operate with publicity for the scholarship for which they have applied. This
publicity may include the material provided in your application, photographs and interviews with
scholarship recipients.

I, ................................................................................................... agree to the above conditions in

respect of this scholarship application/s.

Signed:...........................................................Date:................................................................

ADVICE TO APPLICANTS

Applications must arrive by the date shown on the application form. Any late applications will be at the
discretion of the RMLA Scholarship Selection Committee.

Please do not send original birth certificates or other original documents. Please do not place your
application into any sort of folder. Simply attach all pages with ONE staple in the top left hand corner. All
pages should be A4 size and on plain white paper.

If you have any queries regarding your eligibility or how to apply, please contact the RMLA Scholarship
Selection Committee, RMLA, PO Box 89187, Torbay, Auckland 0742 on telephone 027 272 3960.