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Application Form

Application Form

Personal Details

First Name

Middle Name

Last Name

Date of Birth

Email Address

Address (during academic year)

City

State

Postcode

Country

Postal Address

City

State

Postcode

Country

Phone

Current Tertiary Education

Name of University or TAFE College

Current enrolment degree/diploma course (include Major)

Year of course commencement

Proposed completion date of degree/diploma

Confirmation of enrolment for 2022, subjects passed and subjects enrolled for 2023.

No file chosen

Please attach to statement of academic record to application

Activities and Achievements

(Please describe or indicate ‘nil’)

Past or present extra–curricular activities, hobbies, club or organisation memberships (including any offices held), community involvement or other achievements that you consider are relevant

Academic prizes, awards and other academic achievements

Summary of employment or work experience (past and present)

Supporting Information

What are your future professional and personal goals?

Please outline how this bursary will assist you in completing your degree

References

Attach two written references (one professional and one personal) that confirm the applicant’s eligibility and suitability to meet the requirements of the Award.

Name of professional referee (This may be a lecturer)

Email Address

Telephone

Name of personal referee (This may be someone that has known you a long time).

Telephone

Email Address

Statement

The information I have provided in this application is, to the best of my knowledge, true and accurate. Incorrect and/or incomplete information relating to this application is my responsibility and may result in my application being deemed inadmissible and/or the withdrawal of any offer for award.

Your Name