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MSI scholarships application

To be submitted by November 30

Scholarship:

Title:

Given name(s):

Family name:

Date of birth:

Mailing address:

Telephone number for yourself or family member

Day:

Evening:

Fax:

E-mail address:

If you are already a student of this university, your academic record will be available to the selection committee. Please provide your student number:

If you are seeking transfer to ANU from another institution, have you applied for admission to the University?

If "NO" please phone the University Admissions Office on (02) 6125 3453 for an application form.

Please provide the full name of the institution at which you are currently studying and the degree course being undertaken.

Institution:

Degree Course:

If you are not an ANU student you must post or fax to the MSI an official transcript of your academic record to date, and then forward the results of any examinations currently being undertaken as soon as they are available to you. Send documents to

Katie Lau
Dean's office
Mathematical Sciences Institute, Bldg 27
Australian National University
Canberra, ACT 0200

facsimile : (02) 6125 0759
email: dean.assistant@maths.anu.edu.au

Area of interest for honours specialization (if known):

If you wish to make any comments with reference to the preference criteria, please use the following field:

Intended starting date:

You need to supply the details of two academic referees who can comment on your suitability for a scholarship. You must supply each of them with a printed copy of a questionnaire in support of your application, available as a PDF, or RTF file. (You can download these now or after filling out this form.)

Details of referee 1

Title:

Name:

Mailing address:

Telephone numbers

Business hours:

After hours:

Fax:

E-mail address:

Details of referee 2

Title:

Name:

Mailing address:

Telephone numbers

Business hours:

After hours:

Fax:

E-mail address:

If you wish to make any comments regarding your academic record, or would like to request further information, please use the following field:

I wish to be considered for an MSI Scholarship. I will not be in receipt of any scholarship or award of the same value or greater awarded by this university or any other cource while I am holding the MSI Scholarship. I authorise the University to obtain official records from any educational institution previously attended by me, and acknowledge that the University reserves the right to vary or reverse any decision regarding admission and enrolment made on the basis of incorrect or incomplete information.