AUTHENTICITY DECLARATION

Scholarship Music
Candidate name:
NSN number:
School name:

School no:

Checklist
Tick a box to indicate for which of the following specialties the candidate is submitting a portfolio of
work:
Performance
Composition
Musicology
Tick a box to indicate the form(s) in which the material has been submitted. 1 You may tick more
than one:
Written materials

Multimedia material e.g. PowerPoint

Visual material (DVD/video)

CD of audio material

Performance scores

Compositional scores

Declaration
CANDIDATE
This work presented for assessment is my own. I have included references to all external sources.
Tick this box if you do NOT give permission for NZQA to use this work as an exemplar.
Signature: .....................................................................................

Date: ......................................

TEACHER
I am confident that this candidate has had the opportunity to produce a submission which meets
authenticity requirements for external assessment.
Teachers name: ...........................................................................
(please print)

Signature: .....................................................................................

Date: ......................................

NO materials are to be submitted on USB devices. Material submitted on USBs will be returned to the
school prior to marking.
1