Application form for NZELTO Intake 55

NEW ZEALAND ENGLISH

LANGUAGE TRAINING FOR
OFFICIALS
Intake 55
28 July 2020 to 12 December 2020
Theme: Good Governance
IELTS range: 4.5 – 5.5

OFFICE USE ONLY

Applicant name:
Country:
Date:
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NEW ZEALAND ENGLISH LANGUAGE TRAINING FOR OFFICIALS

The New Zealand English Language Training for Officials (NZELTO) scheme, funded by the New
Zealand Aid Programme and managed by New Zealand’s Ministry of Foreign Affairs and Trade, offers
English language training programmes for government officials from Asia and Africa.
Further information on NZELTO, including eligible countries and the application process, is available at
https://www.mfat.govt.nz/en/aid-and-development/new-zealand-government-scholarships/new-
zealand-government-scholarships-on-offer/new-zealand-english-language-training-scholarships-for-
officials/

SECTION 1: APPLICATION CHECKLIST

It is important that you correctly fill out all relevant sections in the application form and include all
documents listed below. Incomplete forms can cause delays with your application and may also lead
to your application missing the closing date.
Documents attached to this application must be certified1 true copies of originals with the official stamp
of the school/institution where relevant, or from a Justice of the Peace, Solicitor, Notary Public or other
authorised official. Where original documents are not in English, you must provide certified true copies
of official English translations.
Please submit your completed application form to the coordinating agency listed for your country
(see Annex 1).

Ensure that your completed application form includes the following:

 A completed eligibility checklist (Section 2).
 A certified copy of the personal pages of your passport (or an alternative form of photo
identification if you do not hold a passport).
 A current curriculum vitae (in English).
 A current job description stating your position title and outlining your responsibilities and
duties (in English).
 Where available, certified copies of your International English proficiency test results, such as
International English Language Testing System (IELTS) or Test of English as a Foreign Language
(TOEFL), from within the last 18 months.
Please confirm the following:
 I confirm that all information in the application is correct and all relevant information required
in the checklist has been attached.

1 A certified copy is a copy (often a photocopy) of a primary document that has on it an endorsement or certificate that it is
a true copy of the primary document.
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SECTION 2: ELIGIBILITY CHECKLIST

To apply for a New Zealand English Language Training for Officials scholarship, you must meet the
following criteria:
Yes No
1. I am a citizen of one of the following countries: □ □
Cambodia, Indonesia, Lao PDR, Mongolia, Myanmar, Timor-Leste, Viet Nam
2. From the date my application is submitted, I will have lived in my country of □ □
citizenship for the last two years or more.
Exception for diplomatic corps and their family: A member of the
diplomatic corps or a dependant of a member of the diplomatic corps, living
outside their own country, can apply for a scholarship.
3. I am not a citizen or permanent resident of any the following countries: □ □
New Zealand, Australia, Bahrain, Canada, Chile, any European Union
country, Iceland, Israel, Japan, Kuwait, Norway, Oman, Qatar, Russia, Saudi
Arabia, Seychelles, Singapore, South Korea, Switzerland, the United Arab
Emirates, the United Kingdom and the United States of America.
Exception: Timor-Leste-Portuguese dual citizens can also apply.
4. I will be between 25 and 45 years old at the time I start the scholarship. □ □
5. I am not currently serving in the military. □ □
6. Within the last five years I have not had a New Zealand Scholarship □ □
terminated.
7. I am currently employed as a government official who needs to use English □ □
frequently in my work and have a direct connection to the course theme.

You must also acknowledge and agree that:

I have received endorsement from my employer to attend this training □ □
programme.
I expect to meet the English language entry requirements for the training □ □
programme.
I expect to meet Immigration New Zealand requirements for a visa. 2 □ □
I will not bring dependants with me to New Zealand while I am on scholarship. □ □
I am committed to returning to my home country for one year or more at the end □ □
of my scholarship to contribute to my country’s social and economic
development.3

2 Visa types are determined by Immigration New Zealand at the time of application. Contact your nearest New Zealand
diplomatic post for further guidance.
3 If you go on to work for your home government on a diplomatic assignment overseas you are exempt from this requirement.
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SECTION 3: PERSONAL INFORMATION

First name(s)

Family name

Preferred name

Note: Names must be as they appear in your passport / birth certificate

Date of birth
(dd/mm/yyyy)
 Female

What best describes  Male

your gender  Prefer not to say
 Prefer to self-describe _______________________

Place & country of birth

Country of citizenship
Second country of
citizenship (if you have
dual citizenship)
List any languages you
speak (other than
English)

Passport number

Is this a diplomatic
 Yes  No
passport?
Place of issue

Date of issue

Date of expiry

Do you suffer from any illness or disability that might affect your
ability to participate in the course (for example, psychiatric condition,
asthma, diabetes, significant visual impairment, motor disability or
significant hearing loss)? A ‘Yes’ answer will not affect your chances of
successfully obtaining a scholarship.  Yes  No
If you have answered ‘Yes’, please provide brief details of the illness or
disability and any special requirements or support you may require to
complete the course on a separate sheet of paper. Please attach a
copy of your doctor’s assessment of your needs.

Applicant contact details: Please give an address where you can be contacted when a decision on
your scholarship is reached. You may not be offered a scholarship if you cannot be contacted.
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Number and street

name
PO Box number

Suburb/village

Town/city

District/Province

Country

Post code

Home phone number

Work phone number

Mobile phone number

Email address (enter
more than one if
relevant)
Emergency contact details: Name someone we can contact in an emergency

Name

Relationship to you
Number and street
name
Suburb/village

Town/city

Country and post code

Home phone number

Work and/or mobile
phone number
Email address
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SECTION 4: LEARNING OBJECTIVES

1. What are the learning
outcomes you hope to
achieve from the NZELTO
training programme?
Please include a description
of any particular skills and
knowledge you want to gain
from your training.
Please be as specific as
possible in no less than 250
words.
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How would the outcomes

described above enhance
the work your ministry is
engaged in?

What are your career

aspirations and how would
the NZELTO course assist
you in achieving these
goals?
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SECTION 5: CURRENT POSITION

Current position title

Department (or
equivalent)
Ministry

Start date (month/year)

Provide a brief job

description, outlining
your responsibilities
and duties.
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How do you use English

in your work?

How often do you use  Every day

English in your work?  Several times each week
 Several times each month
 Several times each year
 Not often
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SECTION 6: EMPLOYER INFORMATION AND ENDORSEMENT

This section must be completed in English by your employer (a manager/supervisor).

Full name

Position title

Name of organisation

Address of organisation

Work and/or mobile

phone number
+ (country code) (number)

Email address

Do you support this  Yes  No

application?
By selecting yes, you are confirming that the applicant is a current
employee and is able to be temporarily released from their duties for the
duration of the training programme.
Do you confirm this
applicant will remain an
employee upon return  Yes  No
from the training
programme?

Signature

Date

Official stamp
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SECTION 7: CURRENT STUDY AND STUDY HISTORY

Indicate your current  Studying full-time

status  Studying part-time
 Not currently studying

If you are currently  Tertiary training/technical certificate

studying, indicate at  Undergraduate diploma
which level
 Bachelor’s degree
 Postgraduate diploma
 Master’s degree
 Doctorate (PhD)
 Other (please state) _________________________

Provide the following information for all completed and partially completed secondary, vocational
and/or tertiary qualifications. List the most recently completed or current qualification first.

Qualification name

Major subject(s)

Education institution

Institution location
Start and end dates of
study (month/year)
Qualification name

Major subject(s)

Education institution

Institution location
Start and end dates of
study (month/year)
Qualification name

Major subject(s)

Education institution

Institution location
Start and end dates of
study (month/year)
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SECTION 8: CURRENT TRAINING AND TRAINING HISTORY

Provide the following information for the last three training courses you completed or are currently
completing, including professional development and/or English language training. List your most
recent training course first.

Name of training course

Institution/organisation

Country

Start and end dates

Name of training course

Institution/organisation

Country

Start and end dates

Name of training course

Institution/organisation

Country

Start and end dates)

SECTION 9: CURRENT OR PREVIOUS NEW ZEALAND SCHOLARSHIP

Have you ever been the  Yes  No
recipient of a
If you answered Yes, please complete this section. If you answered No,
New Zealand
scholarship? skip this section.

Scholarship name

Scholarship duration
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SECTION 10: ENGLISH LANGUAGE PROFICIENCY

To be eligible for this training programme, you must have a certain level of English language
proficiency.
Please attach any evidence of English language proficiency to this application form, as required in
the application checklist in Section 1.

Is English your first  Yes  No

language? If you answered No, please complete this section. If you answered Yes, skip
this section.

Have you been taught

in the medium of  Yes  No
English?
If you have been  Primary school
taught in the medium  Junior secondary/high school
of English, indicate at
which level.  Senior secondary/high school
 Undergraduate or postgraduate level
 While training for my job
 Other (please state) _________________________
Please indicate if you
have completed an
 Yes  No
IELTS/TOEFL test but
are waiting for results.
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ANNEX 1: COORDINATING AGENCIES POSTAL ADDRESSES

Note: This table is for your information only and is not required as part of your application.

Cambodia Ministry of Foreign Affairs and International Cooperation

No 3, Samdech HUN Sen Street, Sangkat Tonle Bassac, Khan Chamkamon,
Phnom Penh, Kingdom of Cambodia.
Tel: (+855) 23 214 441; (+855) 23 216 122
Website: www.mfaic.gov.kh
Indonesia Ministry of State Secretariat
Bureau for Technical Cooperation, Ministry of State Secretariat Building,
Jalan Veteran III No.9-6th Floor, Jakarta 10110
Email: joko.tulodo@setneg.go.id/; jeska_ds@setneg.go.id

Lao PDR Ministry of Foreign Affairs

23 Singha Road, Phonesay Village, Xaysettha District, Vientiane, Lao PDR.
Tel: (+856) 21 415 822
Website: www.mofa.gov.la
Mongolia Ministry of Foreign Affairs
Peace Ave – 7a, 14210, Ulaanbaatar, Mongolia.
Website: http://www.mfa.gov.mn/?lang=en

Myanmar Ministry of Investment and Foreign Economic Relations

Office No (1), Nay Pyi Taw, Myanmar
Tel: 067-407775 (Ministry office); 067-407155 (Scholarships)
Email: scholarshipferd@gmail.com
Timor-Leste Civil Service Commission
Avenida de Portugal, Praia dos Coqueiros, Dili, Timor-Leste
Viet Nam Ministry of Planning & Investment
No. 6B, Hoang Dieu, Ba Dinh, Ha Noi, Viet Nam
Tel: (84-80) 43485; (84-24) 38455298
Website: http://www.mpi.gov.vn/en