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 d.harland@uws.edu.au

I approve this scholarship payment for 2016/2017

Name: ________________________________ Position: ______________________

Signature: _________________________________________ Date: ____________