Awards Application Form

Application Type*:
Full Name of Applicant*:
Address*:
Phone*:
Fax:
Email Address*:
Employer's Address (if any):
Work Phone:
Work Fax:
Brief summary of study or project details and the expected benefits for New Zealand's biosecurity:
Details of any other funding applied for or received for this or other recent study:
Declaration: By submitting this application, I confirm that the details given on this form and on the attached papers are provided in good faith and correctly represent the proposed study. I authorise members of the judging panel to contact the named referees to enquire about my professional and personal characteristics.

I have read and understood the declaration*:
Date:
Please attach a brief curriculum vitae and no more than five A4 sized pages detailing*:
a) Your proposed study or project b) Your registration details from your university or tertiary training provider c) The value of the study to furthering New Zealand's biosecurity interests d) The practical relevance of the study to the objectives of the New Zealand Biosecurity Institute e) A brief personal statement f) Contact details for two referees, and their supporting statements

Please type what you see in the box.