Application Form2018

All applicants must complete this form and place on top of every one of your threecopies of documentation that is required.

A school can nominate a maximum of four students. However those nominated students can apply for as many opportunities as they wish.

ELIGIBILITY CRITERIA

(Please read carefully)

  • he applicant must be a New Zealand citizen or have permanent New Zealand residency.
  • The applicant should have a genuine interest in science.
  • The applicant should be seriously considering a career in the science area.These can be taken to include natural, physical, mathematical and information sciences, applied sciences, technology, engineering, social science and multi-disciplinary science

CRITERIA

  • The applicant must be studying at least two science subjects and preferably three and attaining at least a merit and preferably an excellent grade especially in the science learning areas.
  • The applicant must have very good oral and communication skills.
  • The applicant should be involved in the school community in a leadership role or participating in extra curricular school activities.

Please tick any of the opportunities that you would like to be considered for.

USA Space Camp, Alabama(late June - date to be confirmed)□

London International Youth Science Forum(28 July – 8 Aug) □

Youth ANZAAS, Australia, Melbourne(Early July - date to be confirmed)□

FEAST (Future experiences in agriculture, science and technology) (1-5 July)□

XLab, Germany(4 August – 1 September))□

Asia Science Camp, Manado,Indonesia (Date to be confirmed)□

European Space Camp, Norway (10-16 August)□

National Youth Science Forum, Canberra, 2019(January 2019)□

Summer Research School in Mathematics and Informatics, Bulgaria (August Date TBC)□

Bessie F. Lawrence Summer School, Israel (3 – 26 July)□

Surname:

First Names:

School:

Age: DOB: Year Level at School

Address:

Home Telephone:Cell phone:

Email:(Please do not provide a school email address)

Passport Number Issue Date Expiry Date

If you are successful in gaining selection to an event do you give permission for us to use your cell phone number so that media can make contact with you directly. Yes No

Which sciences are you studying this year? Please highlight or circle.

Biology; Chemistry; Physics; AgHort; Earth & Space Science;

Digital Technologies/Computing; Maths with Stats;Maths with Calculus

If you are a Year 11 student applying for the USA Space Camp then please list the subjects that you are studying

_

For Year 12 or Year 13 students

What are your overall science related subject marks for NCEA Level 1 or2?Please tick the appropriate box.

ScienceAchieved□Merit□Excellence□N/A

BiologyAchieved□Merit□Excellence□N/A

ChemistryAchieved□Merit□Excellence□N/A

PhysicsAchieved□Merit□Excellence□N/A

ScienceAchieved□Merit□Excellence□N/A

Earth & Space ScienceAchieved□Merit□Excellence□N/A

AgHortAchieved□Merit□Excellence□N/A

Mathematics/CalculusAchieved□Merit□Excellence□N/A

Mathematics/StatisticsAchieved□Merit□Excellence□N/A

Digital Technologies/

ComputingAchieved□Merit□Excellence□N/A

EnglishAchieved□Merit□Excellence□N/A

How many excellence credits did you gain for Level 1?

How many merit credits did you gain for Level 1?

How many excellence credits did you gain for Level 2N/A

How many merit credits did you gain for Level 2N/A

Have you already undertaken and passed any Level 3 science subjects YesNo

If yes please list and list grade:

Are you undertaking any science scholarship science subjects this year?YesNo

If yes what are those subjects?

If you are not studying NCEA e.g. Cambridge or IB then please list your subjects and marks gained below.

Do you intend to study science/engineering or technology at a tertiary level?

Do you know what area of science you intend to study?

Please tick if you are currently involved in any of the following or participated in 2016. Please tick

CREST□

Biology, Chemistry, IYPT, Maths, Olympiad Training Camps□ (which)

Regional Science & Technology Fair□

Robotics Competitions□

NZ Top Engineering Scientist□

Brain Bee□

Tutoring any science subjects□

Other

Are you a member of an astronomical society □ (which)

Please tick if you have attended any of the following

Hands on Science□

Rotary Science Forum□

Spirit of Adventure□

Other

Are you involved in any leadership areas at school?

What are they?

Do you tutor students at your school and if so what do you tutor?

Are you in a debating team?

Are you involved in any community or voluntary work?

If you answered ‘yes’ please tell us what that is

Instructions

Please sendthreecomplete copiesof the application.

DO NOT BIND or DOUBLESIDE BUT STAPLE TOP LEFT HAND SIDE

Please collate from top to bottom (as listed below):

This Application Form□

1 page letter from youto the panel outlining why youthink you are a suitable applicant□

A testimonial from a teacher of science which must beco signed by the Principal□

NCEA/Cambridge examination results (verified by a teacher’s signature. If you are a

Year 11 student you need to include your school report.□

Curriculum Vitae(1pagemaximum). Please include things that might be of interest

to the panel□

Copy of passport or birth certificate (verified by a teacher’s signature) □

CLOSING DATE

Applications are to bereceived no later than 5pm on 14 March 2018.

If you are posting your application – allow 5 days and post to:

Debbie Woodhall

Project Manager & Event Coordinator

Royal Society of New Zealand

PO Box 598

Wellington

Courier Address - allow 1-2 days and send to:

Debbie Woodhall

Project Manager & event Coordinator

Royal Society of New Zealand

11 Turnbull Street

Thorndon

Wellington

Email applications are not acceptable.

Further information for Teachers and Schools

  • A maximum of four students can be nominated by a school. However these studentscanapply for as many opportunities as they wish by ticking the boxes on the application form.
  • Threecomplete applicationsare to be sent per student applicant.
  • Email applications will not be accepted.
  • Late applications will not be accepted.

If you have any questions please contact Debbie Woodhall at or phone 04 470 5762.

Guidelines for Teachers

Only four students can be nominated in total by any school. However those students can apply for as many opportunities as they wish.

You may like to include in your testimonial the following.

  • Character of applicant
  • Work ethic of applicant
  • Maturity of applicant
  • Academic ability of applicant
  • Is the applicant involved in extra science activities?
  • Does the applicant have a genuine interest in science?
  • Organisational and time management skills of applicant?
  • In what way does the student contribute to the school?
  • Anything else you think is relevant and helpful to the panel in pertaining to the applicant’s suitability