1. First Name
2. Surname

3. Where are you currently studying?
4. What is your current visa/immigration status in New Zealand?

5. What degree/qualification are you enrolled in?

6. When are you intending on completing your tertiary studies?
End of 2018Mid 2019End of 2019Later than 2019Completed

7. What is your location preference?
ChristchurchNelsonDunedinCromwell

8. Do you have a second-choice location preference? If so, please specify; please only include if you would be fully committed to this location if offered.
ChristchurchNelsonDunedinCromwell
9. What is your current GPA or equivalent?
10. What, if any, post qualification study do you intend on completing?

11. Have you been in any paid employment (part-time, casual or full-time) during your most recent academic year?

12. Please indicate what community and/or voluntary activities or initiatives you have been actively involved in over the past 5 years.


13. Do you identify with any Iwi and/or are you Maori?
Yes I identify as MaoriI speak Te ReoYes I Identify with an Iwi
Name of Iwi

14. How did you hear about this Southern Rehab Summer Internship Programme?
Friend or familySouthern Rehab websiteUniversity websiteNoticeboardLecturer messageSocial media

15. Please provide answers to the following questions. For both questions, please use no more than 250 words. a. What motivates you to want to experience working at Southern Rehab for two months of your summer holidays? If you have a particular area of rehabilitation interest please indicate.

b. Please provide a recent example of when you showed initiative by stepping out of your comfort zone, and from this opportunity what did you learn?

Attach your CV

Attach your Academic Transcript. Alternatively, you can supply a current grade print out stamped and verified by the Head of Programmes or a photo of your results.

Attach your Cover Letter