Harry van der Lecq Scholarship


Applications close at the School of Fine Artsat 5pm on 30 September (or, if this is not a business day, by 5pm on the next business day).

LATE APPLICATIONS WILL NOT BE ACCEPTED

Family Name
First Name(s)
UC Student ID
Street Address
Suburb
Town/City
Country
Date of Birth
Nationality / NZ-bornSon or daughter of NZ-born person
Telephone / Cell phone
UC Email / @uclive.ac.nz
Personal Email
Intended programme of study next year (include course names and codes)
Status of intended programme of study / Full-timePart-time
Have you lost a parent through death? / No Yes

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CHECKLIST for Harry van der Lecq Scholarship

  • Please do not put your application into a folder.
  • All pages (excluding transcripts) must be A4 size, printed on one side only.
  • Attach all pages of your application with one paper clip or staple in the top

left-handcorner.

All candidates must

submit to the School of Fine Arts the original application form, which is to be signed and dated

attach a statement describing their “potential to benefit the community and to retain the ideals of individual freedom and of a society organised to give substantial but not overwhelming rewards and authority to persons of character and ability”

attach evidence of “skills in the application of all classic painting and drawing techniques”

attach a certified copy of their birth certificate.

Candidates who are not New Zealand-born must

attach a certified copy of a New Zealand-born parent’s birth certificate.

Candidates who have lost a parent through death and wish this to be taken into consideration must

supply evidence of the parent’s death.

Candidates with tertiary qualifications from another institution in New Zealand must

apply for, or have been granted, admission to the University of Canterbury at the time of making
this scholarship application

attach academic transcripts and diplomas (originals or certified true copies);please include the backs of transcripts if they include the grading scale.

Candidates with tertiary qualifications gained outside New Zealand must

apply for, or have been granted, admission ad eundem statum, at the time of making this scholarship application (see Applying for admission is a separate application process

attach academic transcripts and diplomas (originals or certified true copies);please include the backs of transcripts if they include the grading scale

attach two written academic references in sealed envelopes with the referee’s signature across the seal (references must be originals, A4 size, and signed).

PRIVACY PROVISIONS

The information requested in this application form will be used solely for the purposes of assessing your application for
the Scholarship for which you are applying. Personal information contained in this application will be made available only
to members of the appropriate selection committee. Should you have reason to believe that information about you, supplied
in connection with this application, or in your academic record, is incorrect, you have right of access to, and where appropriate, correction of, that information. References are confidential and will not be released to the applicant without the written authorisation of the referee.

DECLARATION

I have read and I understand the regulations for the above award and the Privacy Provisions, and I agree to abide by the regulations.
Should I be successful with this application, I agree to take part in any publicity that may arise from the award.

I also understand that documentation submitted for this application cannot be returned.

Full Name (Printed):Signature: Date:--20

Applications close at the School of Fine Arts, University of Canterbury, at5pm on 30 September (or, if this is not a business day, by 5pm on the next business day).
LATE APPLICATIONS WILL NOT BE ACCEPTED.

09/15

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