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ULTRIS UNDERGRADUATE LEARNING AND TEACHING RESEARCH INTERNSHIP SCHEME

APPLICATION PROFORMA

2015

Please email this form and other required documentation (see checklist p 3) no later than January 30, 2015, to:

APPLICANT'S DETAILS (to be completed by Undergraduate applicant)

Family Name: / Title (Mr/Mrs/Ms):
Given Names: / Student No: / Full-time:
Part-time:
Your Address: (correspondence will be posted to this address):
Phone No.
(Home): / Phone No.
(Mobile):
University Student Email Address only: / (e.g. )

Note: All correspondence and communications will be sent to this email address.

Do you currently have a job? / Yes / How many hours/week do you work?
No
Do you intend to undertake work in addition to your university studies between February and September 2015? / Yes / No

Will you be available to attend all workshops and Yes No

seminars from February to September, 2015

(see ULTRIS Guidelines 4.1 and 4.2)

Faculty:
If you are a combined degree student please list both faculties / Major/s:

Names of Referees:

·  Name and contact details (nominated Academic Referee - refer Guidelines 5.4):

School:

·  Name and contact details (nominated Academic Referee - refer Guidelines 5.4):

School:

I wish to apply for the ULTRIS. I have read the guidelines and understand that I must be available to attend the workshops and seminars from February to September, 2015.

Applicant’s Signature: / Date:


Checklist of Application Requirements

Attached

Electronic documents
1. This Application Form (Attachment A) completed and signed by applicant / [ ]
2. For students whose academic record to date is from UWA - a copy of the official transcript of academic record.
For students with non-UWA academic record - a certified copy of the official transcript of academic record (and translation if required).(further information relating to UWA’s policy for certifying documents can be found at the following website; www.admissions.uwa.edu.au/page/89777) / [ ]
3. A statement in response to the two selection questions (refer to clause 5.4 of Guidelines). / [ ]
o  What are your reasons for wanting to participate in the ULTRIS?
o  What is your understanding of research in general, and teaching and learning research in particular?

Completed applications should be forwarded no later than January 30, 2015 to: