and conference fee. IES Chairman's Scholarship. (Japan only) ... conference fee. No Scholarship/Full fee ... Postcode: T
CHRYSALIS APPLICATION FORM Sunday 8th December – Sunday 15th December 2013 CHRYSALIS is an exciting opportunity for senior high school students from Australia and around the world to come together for a fun and stimulating week of leadership education, extra-curricular and recreational activities. What the program offers: • • • • • •
7 nights’ accommodation (8th December – 14th December inclusive) and all meals in single room accommodation at Emmanuel College An exciting leadership program with inspiring speakers and group activities Participation in PierSim activities Excursion to Lone Pine Koala Sanctuary Recreational facilities at The University of Queensland and Emmanuel College Gated security and pastoral care within the College I would like to apply for: Scholarship International Student Scholarship IES Chairman’s Scholarship (Japan only) UQ International Baccalaureate Scholarship UQ Domestic Bursary for Australian students and International students (currently residing in Australia) No Scholarship/Full fee paying (AUD $1200)
Inclusions Return economy airfares, accommodation, meals, airport transfers in Brisbane and conference fee Return economy airfares, accommodation, meals, airport transfers in Brisbane and conference fee Return economy airfares, accommodation, meals, airport transfers in Brisbane and conference fee Accommodation, meals and conference fee
Please tick
Accommodation, meals and conference fee
Please indicate if you intend to accept your place in the program if you are NOT awarded a scholarship
Yes / No
Please note such things as visa fees and travel insurance are not included in the above scholarships or fees. Full fee paying students are responsible for making their own way to Brisbane.
2 APPLICANT’S DETAILS: Please provide name as shown on your Passport First Name: Preferred Name:
Family Name:
Date of birth (day/month/year): Gender: Town and country of birth: Nationality (country in which your passport was issued):
M/F
Name of Current School: Present residential address (PLEASE PRINT CAREFULLY):
State: Postcode:
Telephone: ( Email:
)
Mobile telephone:
PARENT/GUARDIAN DETAILS: Title: Surname: First name: Email:
Work telephone: ( Home telephone: ( Mobile telephone:
) )
APPLICATION SUBMISSION In addition to this application form, please submit the following documents when applying for CHRYSALIS 2013 (please check items as completed): 1. A minimum of 250 words on why you want to attend CHRYSALIS 2. Evidence of your current involvement in any community or school-based extra-curricular activities 3. A statement from your school supporting your application 4. A scan of your passport identification page, if you hold one (international students only) If you are applying for one of the international scholarships (i.e. Chairman’s, IB and/or International Scholarship) please also provide the following: 5. Original essay written in English addressing one of the following questions: -‐ What role can social media play in leadership? -‐ Are there particular responsibilities required of leaders in the age of social media? -‐ What challenges and opportunities does social media present to business? 6. Evidence of your English language competency equivalent of IELTS 5.5 Incomplete applications will not be considered for a scholarship or bursary. All applications are to be sent to
[email protected] The Summer School is strictly limited to 40 participants. Applications for all scholarships/bursaries and applications open Monday, 1st July and close Friday, 6th September 2013. Applications received after the closing date will not be considered for scholarships or bursaries. Applications will be assessed after this date and you will be notified of your acceptance into the summer school within 28 days. If you have any questions please email
[email protected]
3 METHOD OF REFERRAL To assist us in further marketing CHRYSALIS, please advise how you heard about the Summer School: Web School staff
Advertising Friend
Agent – Please provide details: Other – Please state:
DECLARATION BY APPLICANT By applying for a place/scholarship in the Chrysalis Young Leaders’ Program, I understand that it is my responsibility to provide all necessary documentation to support this application. I declare that the information I have provided is true and accurate to the best of my knowledge and understand that false or misleading documentation may result in my disqualification for consideration of a scholarship or place. Signature of applicant (if over 18): Signature of guardian (if applicant under 18):
Date: Date:
Disclaimer statement: The information you provide on this common application form will be used only for the purposes of the College’s application processes.
FOR MORE INFORMATION, PLEASE CONTACT CHRYSALIS Organising Committee Tel: +61 7 3832 7699 E:
[email protected] W: www.ChrysalisYoungLeaders.org When inquiring please ask for Anton Crace or Reid Arkinstall
