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Ethnic Postgraduate Students Research and Writing Retreat Application
Ethnic Postgraduate Students Research and Writing Retreat Application
Surname
Student ID
Number
Contact
Number
Telephone
Address
Mobile
Doctors Name
Doctors
Telephone
Te Ara Poutama
Programme of
study:
e.g PhD, MPhil
Supervisors
Name:
Clearly identify which stage of research you are at (eg. PGR1, PGR2, PGR9, Ethics,
etc):
What activities would you like to be included in the programme for the Writers
Retreat?
Briefly state what you would like to achieve from attending the Writers Retreat:
Supervisor Name:
Signature:
Accommodation: (Please indicate whether you would stay overnight at the retreat venue)
Live-in (overnight accommodation)
Meals: (Please indicate your dietary requirements using the boxes below.)
Vegetarian
Vegan
Gluten free
Halal
Other
Please specify:
_____________________________
Medical Conditions: (Do you have now, or have you ever had any medical conditions that
we should know about? If so, please list the conditions below)
Physical Conditions: (Do you have now, or have you suffer previously with any physical
conditions that we should know about? If so, please list the conditions below)
Exp:
WOF Exp:
Release of information
I agree to the University Postgraduate Centre using appropriate photographs
of my involvement within the Retreat for advertising purposes pertinent to
University Postgraduate Centre future events and workshops.
Participants Declaration:
The information that I have provided in this application is accurate and complete.
I acknowledge that I have a responsibility to work safely off campus, taking reasonable
care to protect my own health and safety and that of any other participants.
I agree to comply with all procedures and directions provided by the facilitators of the
Writers Retreat.
Signature:
Date:
Please return the completed application form to the University Postgraduate Centre,
WU501A, on the City Campus, or to email address postgraduate.centre@aut.ac.nz.