Locked Bag 1797Penrith NSW 2751 Australia
HAWKESBURY INSTITUTE FOR THE ENVIRONMENTSUMMER RESEARCH SCHOLARSHIPS
APPLICATION FORM – 2016/2017
Name: Student ID:
Postal address:
Telephone: Facsimile: Email:
Name of proposed supervisor:
Proposed title:
Brief outline of proposed project (100 words max):
What resources will be required to complete the project?
Student Signature: __________________________________ Date: ____________
The Institute will access a copy of your undergraduate academic transcript. If you are not previously a UWS student, please attach a transcript showing your Grade Point Average or equivalent.
This section is to be completed by your proposed supervisor:
Are you willing to supervise this project? □ Yes □ No
Are the resources available to complete this project? □ Yes □ No
Signature: __________________________________ Date: ____________
Once signatures are obtained, please forward this application and accompanying documentation to be received no later than Friday 4 November 2016
Dr David HarlandRoom G.67, Building R2, Hawkesbury CampusLocked Bag 1797, Penrith, NSW, 275102 4570 1125 or [email protected]
I approve this scholarship payment for 2016/2017
Name: ________________________________ Position: ______________________
Signature: _________________________________________ Date: ____________
