Go Further Indigenous Tertiary Scholarship. Application form

Transcription

1 2019 Go Further Indigenous Tertiary Scholarship Application form

2 SECTION ONE: PERSONAL DETAILS Student number Gender Male Female Other Title Mr/Mrs/Miss First name Family name Address and contact details Street Suburb State Postcode Telephone (home) Mobile Do you identify with one of the Traditional Owner groups to whom Arrow Energy has capacity-building obligations through land use agreements? 10% weighting. Applicants who do not identify with one of these groups will receive zero in this criteria Yes No (if yes please indicate which group/s) Surat region Barunggam Bigambul Cobble Cobble Emon/Iman Mandandanji Jarowair/Yarowair Kambuwal Northern Gomeroi/Gomeroi Wakka Wakka/Western Wakka Wakka Bowen region Barada Barna Birri Jangga Wiri Yetimarala Where did you find out about the Go Further Indigenous Tertiary Scholarships? Website Lecturer Another student Other Are you and Australian Citizen or permanent resident? Yes No 2 Go Further Indigenous Tertiary Scholarship Application form

3 SECTION TWO: ACADEMIC RECORD AND PROFESSIONAL QUALIFICATIONS What course are you studying at QUT? Major Will you be enrolled part-time or full-time at QUT in 2019? Part-time Full-time (Proof of enrolment will be verified prior to payment after course dates) Please indicate the course you are enrolled in Select one List any special awards, prizes or other achievements you have accomplished If successful, do you agree to undertake the course part-time or full-time during the term of the scholarship in 2019? Part-time Full-time 3 Go Further Indigenous Tertiary Scholarship Application form

4 SECTION THREE: SCHOLARSHIPS RESPONSE QUESTIONS A written submission of 500 words or less, for each question, in your own words 1. Give examples of your academic ability and potential to achieve at university (30% weighting). 4 Go Further Indigenous Tertiary Scholarship Application form

5 2. Describe your personal attributes e.g. community involvement, career aspirations, interests, drive, ability to overcome adversity (30% weighting). 5 Go Further Indigenous Tertiary Scholarship Application form

6 3. Impact of the scholarship. How will the Go Further Indigenous Tertiary Scholarship assist you in achieving your current and future career goals? (30% weighting). SECTION FOUR: SUPPORTING EVIDENCE Applicants should attach documentary evidence of additional material that they believe will support their scholarship application, including: academic transcripts (from high school, TAFE and/or current/previous study) academic transcript if a continuing QUT student (Please attach a copy of your academic record from QUT Virtual) certified copy of documentation supporting Aboriginal and/or Torres Strait Islander heritage (if not already provided to the Oodgeroo Unit, QUT) a current resume/curriculum vitae referee reports, published research etc evidence of Australian Citizenship or permanent residency 6 Go Further Indigenous Tertiary Scholarship Application form

7 SECTION FIVE: DECLARATION I declare that, to the best of my knowledge and belief, all the information I have provided is true and correct. I understand that the submission of false information in my application will result in the disqualification of my application. I have read and understood the conditions of this scholarship and have included the required documentary evidence (see checklist on page 6). I agree to assist with promotion of the scholarship through participation at Oodgeroo Unit, QUT and Arrow Energy promotional/recruitment events if required. Signature Date TAX AND OTHER BENEFITS IMPLICATIONS Scholarship payments will contribute to recipients taxable income and may also impact entitlement to Commonwealth benefits such as ABSTUDY. Scholarship applicants and/or recipients are encouraged to contact Centrelink, the Australian Taxation Office (ATO) and/or their taxation agent to obtain advice about the implications of the scholarship payments on current earnings and benefits. Information about taxation on scholarships is also available from the ATO website at: PRIVACY The Oodgeroo Unit, QUT collects the personal information on this form to assess your scholarship application and for other University purposes upon enrolment. Information explaining how QUT manages students' personal information can be found at GO FURTHER INDIGENOUS TERTIARY SCHOLARSHIP: APPLICATION CHECKLIST The following documentation is required to support your completed Go Further Indigenous Tertiary Scholarship application form. academic transcripts (from high school, TAFE and/or current/previous study) academic transcript if a continuing QUT student (please attach a copy of your academic record from QUT Virtual) certified copy of documentation supporting Aboriginal and/or Torres Strait Islander heritage (if not already provided to the Oodgeroo Unit, QUT) a resume/curriculum vitae referee reports, published research etc evidence of Australian Citizenship or permanent residency (where applicable) To submit your application complete the Go Further Indigenous Tertiary Scholarship application form all supporting documents as listed above to information.oodgeroo@qut.edu.au by the closing date. APPLICATIONS CLOSE FRIDAY 1 MARCH Go Further Indigenous Tertiary Scholarship Application form