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|(Please note that the name entered should be your full names as it appears on your birth certificate or passport.) |

|First Name | |Last Name | |

A1 SCHOLARSHIPS INFORMATION

▪ Deadline for COMPLETED PRE APPLICATION FORMS closes on FRIDAY, 8th May 2015. Therefore all applications must reach the Ministry of Education (MoE) by the given date and time. Address all applications to: Scholarships, Ministry of Education, PO Box 97, Rarotonga, COOK ISLANDS.

▪ 6 New Zealand Pacific Scholarships (NZPS) available! Five (5) awards are for multi-year studies and one (1) one-year award. Studies must be towards a new tertiary qualification at an approved NZ tertiary institute. This scheme is funded via NZ Studylink (loan and allowances) and the NZAid programme. Student loans will be paid back by the NZAid programme based on an awardees’ employment in the Cook Islands after completion of studies. Where the proposed study programme is available at institutes within the region, the scholarship award is prioritised to the region rather than to NZ.

3 Regional Development Scholarships (RDS) available! You can study towards a tertiary qualification at a regional tertiary institute that is in Fiji, Samoa or Vanuatu.

General eligibility:

▪ Scholarships are available to resident Cook Islanders and Permanent Residents holding NZ citizenship.

▪ Recipients must travel on valid NZ passports if awarded the NZPS & RDS Scholarship.

▪ Scholarships are for full time studies (i.e. academic, technical or vocational course programmes) at an approved tertiary institute.

▪ Upon completion of award the recipient will be required to:

• Return home to contribute to the economic and social development of the Cook islands; and

• Stand down normally for a period of two (2) years before applying for a MoE administered scholarship including an NZAID Short Term Training Award (STTA).

▪ Scholarships awards will be prioritised to the following subject areas that are relevant to the development needs and employment opportunities of the Cook Islands.

▪ Agriculture; Renewable energy; ICT;

▪ Marine/Fisheries; Tourism Health

▪ Waste management; Finance Management; Public Sector Management

▪ Business /Entrepreneurship; Environmental Management

▪ Education (Secondary teaching: especially for Maths, English and Science subjects)

▪ Other areas may be considered (excluding Aviation, Civil Engineering and Architectural studies)

▪ All information that provide will be kept CONFIDENTIAL and will be used for MoE purposes only.

A2 INSTRUCTIONS FOR FILLING IN THIS APPLICATION FORM

▪ Please answer all questions concisely. Please do not put down abbreviations. Provide full names for acronyms used in any of the documents attached. For questions not applicable to you, answer with “ N/A or a dash ( - ) ”

▪ If you need more space, attach additional pages, making sure to indicate the number of the question you are answering.

A3 ELIGIBILITY CRITERIA:

A3.1 For MOE to consider your application, it is compulsory for you to meet ALL of the following criteria. Please tick circles to confirm that you meet ALL of the following criteria:

|NZPS & RDS |

|( You must be a resident Cook Islander with a valid New Zealand passport |

|( You have resided in the Cook Islands two (2) years prior to the date of this application |

|( You do not hold a MOE administered Scholarship or have not been on a MOE administered scholarship two (2) |

|years prior to the date of this application. |

|( Be available to commence your academic studies in New Zealand at the start of the New Zealand academic year |

|in February 2016 |

If you meet ALL of the above criteria, continue to A3.2 Activity status.

If you DO NOT meet ALL of the above criteria, we regret advise that you are not eligible to apply for a scholarship under the preferred scheme at this time. For those currently overseas studying towards a tertiary qualification at their own cost, please look out for our ads in the local papers or our MOE website for Overseas Student Assistance Funding and Cook Islands Government Scholarships to NZ.

A3.2 ACTIVITY STATUS

What is your main activity status? Tick one circle only

|( Working full time. |( You are studying at tertiary level full time |

|( Working fulltime and studying at tertiary level |( You are studying at secondary school. |

|FULL TIME | |

|( You are working full time and studying at tertiary |( You are not studying or currently employed. |

|level PART TIME | |

|( You are working part time and studying at tertiary | |

|level PART TIME | |

A3.3 ACADEMIC MERIT:

You are applying on the basis that you have met the minimum scholarship academic merit as follows. Please tick appropriate circle:

|( You have achieved a minimum of 70 credits or more in five (5) NCEA Level 3 subjects with a minimum of at least 14 credits in three (3) core subjects|

|relevant to proposed programme of study and two (2) subjects from other domains;. You will be allocated a rank score based on your best 70 credits at |

|Level 3 or higher over a maximum of five approved |

|subjects, weighted by the level of achievement attained in each set of credits e.g. Achieved (A) = 2points, Merit (M) = |

|3 points, Excellence (E) = 4points; AND |

|( You have achieved literacy and numeracy requirements at University Entrance (UE); OR |

|( You have achieved a ‘B’ Bursary or better OR |

|( You have achieved a ‘B’ grade average in at least 4 compulsory foundation papers/units towards proposed course |

|programme, OR |

|( You have the equivalent of the above qualifications. |

It will be to your advantage if:

|( You have researched the course programme of interest with its admission requirements at the preferred University; |

|( You have relevant work experience towards proposed course programme. |

Your application will be assessed according to the compulsory submission of the following documents. Non-submission of any one of the following documents may deem your application as incomplete and will not be considered.

A3.4 APPLICATION CHECKLIST:

Your application will not be processed unless all information required is supplied.

Please tick boxes and ensure that you have enclosed the following documents:

|( Copy of your Birth Certificate and Passport Detail page; |

|( Copy of Secondary School qualifications gained. For NCEA L3 applicant you will need to attach copies of your |

|NCEA Level 1 and Level 2 Records of Achievement with official summaries of excellences, merits and achievements |

|gained by subject and units achieved. For the purpose of the scholarship pre-selection in May, your ranking score will |

|be based on your Level 2 results. We will also be looking at consistency of academic performance from level 1. |

|( Copy of Tertiary qualifications official academic transcripts for complete or incomplete qualifications that specify |

|grades or credits achieved. Copies of academic qualifications/transcripts as indicated on your CV must be attached; |

|( Copy of Curriculum vitae (CV) outlining your personal details and in order of education history including academic |

|qualifications and work-related experiences. This should be no more than 4 pages and up to date as of April this year; |

|( If you are employed a copy of your current job description confirming your position and outlining your |

|responsibilities and duties. |

|( For NZPS, three references (no more then 12 months old) on official letterhead, supporting your scholarship |

|application. References should be provided from your current employer and former lecturer (or school principal or |

|teacher for undergraduate applicants), and where possible, a relevant government or community based organisation. |

|( A 500 word statement describing how your proposed area of study will enable you to contribute to the Economic and |

|Social development of the Cook Islands. |

|( A 500 word statement describing the specific skills and knowledge you want to gain from your proposed study and |

|how this will contribute to your current and/or future job. |

|( For Masters and Doctoral research students, a 500 word statement outlining your proposed research topic, objectives, |

|relationship of this research to previous work in this field by others and yourself (literature review), Significance and possible |

|application of your proposed research to the development of the Cook Islands, proposed research method, research plan and |

|timeline for completion. |

|Do not send in an application without all the required documentation |

A4 SCHOLARSHIPS PROCESS

▪ Only completed application forms with all supporting documents for applicants that meet the eligibility criteria will be considered. The Scholarship Committee will assess, short list, then make final selection of successful candidates. Interviews will be for those short listed for overseas scholarships. For current NCEAL3 student on the shortlist, awards are conditional and are based on final results achieved. The decision of the Committee is final, and no appeal for consideration is allowed.

▪ All applicants will be advised individually of the outcome of their applications by May.

▪ Thereafter an information paper will be provided to Cabinet with a list of Final RDS, NZPS, & Commonwealth recipients. The official announcement of successful applicants will be made in January 2015 at the MOE Tertiary Graduation Ceremony.

Q1. PERSONAL DETAILS

|(Please note that the name entered in this section should be your full names as it appears on your birth certificate or passport. Attach a copy of the |

|relevant document) |

|First Name | |Also known as | |

|Middle Name | |Maiden Name | |

|Last Name | | | |

|Q1.1 Date of Birth: |

|( Other (please specify): _____________________________________ (Go to Q1.4) |

Q1.4 Residential status: (circle appropriate answer(s)) Permanent Resident/ Married to a Cook Islander

Q1.5 Country of Citizenship (as stated in your passport):

Passport Number: Passport Expiry date:

Q1.6 Postal Address and Contact Details within the Cook Islands:

|PO Box: | | | | |

|Village: | | | | |

|Island of Usual Residence: | | | |

|Home Phone: | |Mobile: | | |

|Work Phone: | |Fax Phone: | | |

|Email: | |

| |(Please ensure that the email address provided is one that you check regularly as this will be MOE’s main |

| |communication channel) |

Q2 HISTORY WITH MOE/DNHRD SCHEMES

Are you currently on a MOE scheme or have you been on any MOE/DNHRD Scheme in the past two (2) years prior to the date of this application?

Yes/No (If No, please go to Q3)

|Scheme |Year(s) |Scheme |Year(s) |

|( New Zealand Development Scholarship (NZDS) | |( Cook Islands Government Scholarship (CIGS) | |

|( NZAid/AusAid Regional Development | |( In country Tuition Award Scholarship (ITAS) | |

|Scholarship (RDS) | | | |

|( Short Term Training Awards to NZ (STTA) | |( C. Is Hospitality & Tourism Training Centre | |

|( Overseas Private Student Assistance Fund (OSAF) | |( C. Is Trade Training Centre | |

|( In country Student Assistance Fund (ISAF) | | | |

Q3 Scholarship Preferences:

Please tick circle for scholarship preference. If you have more than one preference, rank in order of preference:

1 for high preference to a 3 for low preference

|( New Zealand Aid Pacific Scholarships (NZPS) for undergraduate or postgraduate full time studies in New Zealand. |

|( NZAid and AusAid Regional Development Scholarship (RDS) for full time undergraduate or postgraduate studies at Pacific |

|Regional Tertiary Institutes such as the University of the South Pacific in Fiji & Fiji School of Medicine and other approved regional |

|tertiary Institutes. |

Q3.2 Disabilities or special needs:

Do you have any special requirements which you may need to assist you with your study (e.g. wheelchair access)? A ‘Yes’ answer will not prevent you from consideration for a scholarship.

Yes/No (If ‘No’, go to Q3.3)

If yes, please specify ___ ______________ ______________________________

Q3.3 DETAILS OF PROPOSED STUDY PROGRAMME:

Scholarships are offered to applicants with study programmes that will benefit the development of the Cook Islands. For proposed courses and level of study, it is important to choose according to a national priority training need for our nation. It is recommended that you research the proposed course programme you intend to pursue. Please make your choice carefully

Be specific and identify the qualification with its major subject(s). Your first order on the list will be considered your first preference for study programme, training provider and training provider location.

|Current OR Proposed Study Programme |Major Subjects (e.g. Accounting, ICT, |Training Provider |Training Provider Location including|

| |Environment, Marine Studies) | |city, Country where applicable |

|1. | | | |

|2. | | | |

Q4 EDUCATION HISTORY

Q4.1 SECONDARY SCHOOL QUALIFICATIONS

Q4.1.1 Are you currently at secondary school? Yes/No

Q4.1.2 What is your highest secondary school qualification gained? _____________________________________________

|Q4.1.3 Secondary (College)/Adult Education Qualifications: |

|(Please attach final results/exam transcripts and/or Qualification |

|NZSC |6FC/Preliminary papers |Bursary/Foundation Papers/7FC |

|Name of Institute: |Name of Institute: |Name of Institute: |

|Year(s) of Attendance: | |Year(s) of Attendance: | |Year(s) of Attendance: | |

|Subject/unit standards completed |Final Grade |Subject/unit standards completed |Final Grade |Subject completed |Final Grade |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

Q4.1.4 For NCEAL1 to NCEAL3 results. Please attach official Record of Achievement and Summary by subject areas.

|Subjects taken or currently in |NCEAL1 |NCEAL2 |NCEAL3 |

|process | | | |

| |NA |A |M |

|Year of Attendance (e.g. 2012) | | | |

| | |

|Name(s) of Tertiary Institute | |

|Start date (month/year) |End date (month/year) |Grade Point Average | |

| | |(GPA) | |

Q4.2.4 OTHER tertiary qualification(s) GAINED (Please attach Results/transcripts)

|Name of OTHER tertiary qualification | |

|gained | |

|Name(s) of Tertiary Institute | |

|Start date (month/year) |End date (month/year) |Grade Point Average | |

| | |(GPA) | |

Q4.2.5 Tertiary Qualification IN PROGRESS (Please remember to attach results/transcripts)

|Name of tertiary qualification in PRogress | |

|Name of Tertiary Institute(s) | |

|Start date (month/year) |Proposed end date (month/year) |

|List Courses/papers completed: |Final Grade |

| |Awarded: |

| |e.g. Semester 1, 2007 EC100: Introduction to Economics |B |

|1. | | |

|2. | | |

|3. | | |

|4. | | |

|5. | | |

|6. | | |

|7. | | |

|8. | | |

|Total number of courses/units completed | |Total number of courses/units to be completed | |

| | |towards this qualification | |

|Grade point average (GPA) | |

Q5 WORK HISTORY

START from CURRENT or MOST RECENT unpaid and paid work experiences relevant to area of study. (Please attach your CV)

|Year(s) (from – |Organisation/Agency/Ministry |Job Title |Main Responsibilities & Skills acquired |

|to) | | | |

| | | | |

| | | | |

| | | | |

Q6. RELEVANCE OF STUDY TO THE DEVELOPMENT OF THE COOK ISLANDS

Q6.1 Do you intend to return or remain within the Cook Islands after the completion of your scholarship?

Yes/No

Q6.2 Please provide:

|( A 500 word statement describing how your proposed area of study will enable you to contribute to the Economic and |

|Social development of the Cook Islands. |

|( A 500 word statement describing the specific skills and knowledge you want to gain from your proposed study and |

|how this will contribute to your current and/or future job. |

|( For Masters and Doctoral research students, a 500 word statement outlining your proposed research topic, objectives, |

|relationship of this research to previous work in this field by others and yourself (literature review), Significance and possible |

|application of your proposed research to the development of the Cook Islands, proposed research method, research plan and |

|time line for completion. |

The information you provide in your essay will be considered during the Scholarships selection process.

Q7. DECLARATION BY APPLICANT

|I hereby certify the above information is accurate and correct in all aspects. |

|I understand that the Government of the Cook Islands reserves the right to confirm the accuracy of the information in my application with authorities, |

|and the incorrect statements may result in my being declared ineligible for an award. |

|I declare that if awarded a scholarship, I will abide by the provisions of the Cook Islands Government Tertiary Education and Training Awards Policies |

|and will be required to enter a bonding contract with the Cook Islands Government. |

|Date: |Signature: |

|Declaration by the parent or guardian of a trainee aged under eighteen years: I have read the agreement and I have discussed the agreement with the |

|trainee: |

|Date: |Signature of parent or guardian: |

-----------------------

2015-2016 TERTIARY STUDIES

OVERSEAS

SCHOLARSHIPS PRE-APPLICATION FORM

MoE USE ONLY:

Date/time received: _________________

Staff Initials: _________________

MoE ID: ______

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