Application

 

 

 

Below is a plain text of the application form to give you an idea of what we need to know about you:

Sampson Leadership Trust
Scholarship Application 2012
www.sampsonleadershiptrust.com.au  Facebook Page : Sampson leadership trust scholarship

1. The objectives of the trust and the selection criteria are detailed in the “Overview and Guidelines for 2012 Scholarship Applications” document.  Please read this information carefully.
2. Complete each section in full.
3. Type/print all answers clearly in space provided.
4. Only one letter of recommendation will be accepted.
5. Application must be signed by the candidate.
6. Nominees must have the full support of the organisation or corporation they represent.  Individuals may nominate themselves.
7. A short list of applicants will be interviewed in Shepparton by a selection panel of following the close of applications, with applicants informed of the outcome before the end of December.
8. Successful applicants will be required to submit a written report on their study project.
9. Individual scholarships will be awarded up to a maximum value of $8,000, subject to sufficient cost information being provided to justify the requested scholarship amount.
10. Proposed study programs should be able to be completed within a 12 month period (i.e. by December 2013). Proposals that will take longer than 12 months to complete may be considered if special circumstances warrant this.
11. Return applications no later than 12 October 2012, by post or email:
Post: Sampson Leadership Trust
   c/o PO Box 320
   Tatura  Vic   3616
Email:    admin@sampsonleadershiptrust.com.au (note: applications should be signed and scanned for email)

 


PERSONAL INFORMATION

APPLICANT’S DETAILS
Name: ………………………………………………………………………………………………………………

Date of birth: ........../......../..........   M  /  F

Home address: .....................................................................................................................................
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City …………………………………………………………………………Postcode..............
Phone (Home):.............................................. Work:.......................................................
Mobile:.......................................................... Email:.......................................................
First language: ............................Other languages spoken: .........................................................................
Hobbies / interests:
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EMPLOYER’S DETAILS
Employer: ......................................................................................................................................................
Business address:...........................................................................................................................................
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City …………………………………………………………………………Postcode..............
Phone  .........................................................................Email: ......................................................................
Current title/responsibility: .............................................................................................................................
Date of joining current employer:....................................................................................................................
Title/position on joining current employer: ...................................................................................................

 

EDUCATION – Secondary and Tertiary
Institution                              City                 Years From/To                 Major Studies                  Qualification 
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Extracurricular / Leadership Activities
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EMPLOYMENT / EXPERIENCE
Previous employment (in reverse chronological order).
Employer         Title/Responsibility             From/To                     Reason for Leaving   
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What do you consider to be your most significant career achievement to date?
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Please indicate any leadership training/courses/subjects you have completed via studies, employment or voluntary work.
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COMMUNITY ACTIVITIES & ORGANISATIONS
List, in order of importance to you, up to five community, civic, professional, business, religious, social, sports or other involvements.  Please name the organisation, provide approximate dates of involvement, positions held and time involved per week.
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What have you accomplished in these activities that is relevant to the objectives of the Sampson Leadership Trust?
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Study Proposal
Describe your proposed study activity. Details should include the purpose of your study, how it meets the objectives of the Sampson Leadership Trust, the key planned activities and dates for start and completion of key activities (a project plan or Gantt chart can also be attached if desired).
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Cost Estimate
Please provide an estimate of cost for your study proposal. This should include the total cost and the amount sought from the Sampson Leadership Trust.
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Benefit Summary
Provide a brief statement of how your project will be of benefit to the GMID and its communities.
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Referees
Please provide the names and contact details of up to three personal and/or professional referees who can be contacted as part of the selection process. At least one referee should be able to provide informed comment on the merit and likely benefits of your proposed study.

Referee 1:
Name: ……………………………………………………………………………………………………………………………………………………………..
Job title: …………………………………………………………………………………………………………………………………………………………..
Organisation: ……………………………………………………………………………   Contact phone number: …………………………….
Can this person comment on likely benefits of your proposal?                           Yes                              No
Referee 2:
Name: ……………………………………………………………………………………………………………………………………………………………..
Job title: …………………………………………………………………………………………………………………………………………………………..
Organisation: ……………………………………………………………………………   Contact phone number: …………………………….
Can this person comment on likely benefits of your proposal?                           Yes                              No
Referee 3:
Name: ……………………………………………………………………………………………………………………………………………………………..
Job title: …………………………………………………………………………………………………………………………………………………………..
Organisation: ……………………………………………………………………………   Contact phone number: …………………………….
Can this person comment on likely benefits of your proposal?                           Yes                              No

Statement of support:
You may attach a brief statement of support for your study proposal if desired. If such a statement is provided, it should be from a person qualified to comment on the merit of your proposal and its likely benefit to the GMID
Commitment
I understand that if selected, I will organise my work and personal commitments to undertake the proposed study program within the agreed timelines. I also understand that I will be required to enter into a formal agreement setting out the obligations and expectations applying to scholarship recipients.

Applicant’s Signature: ………………………………………………………………………………………….Date: ………………………………..