Equity Scholarships Application Form

Transcription

1 Equity Scholarships Application Fm Full name Student number (if currently enrolled) at William Angliss Institute Select which scholarship(s) you are applying f: The Sir William Angliss VET Scholarship (VIC) The Sir William Angliss VET Scholarship (NSW) The Sir William Angliss Higher Education Scholarship (VIC) The Sir William Angliss Abiginal and Tres Strait Islander Scholarship (VIC/NSW) The Memial Fund Scholarship (VIC/NSW) Nestlé Golden Chefs Hat Scholarship (VIC/NSW) Latrobe Community Health Service Scholarship (VIC) General Infmation f Applicants Please refer to the eligibility requirements on the William Angliss Institute (from hereinafter referred to as the Institute) website The scholarship will be awarded by the Scholarship Selection Committee. The decision is final. Scholarship payments will be made following the census date of the respective semester. Please ensure to make a copy of your application. Do not submit iginal copies of suppting documentation as these will NOT be returned. Application Instructions 1. Complete all sections in BLOCK letters. 2. Ensure you enclose all suppting documentation with this application. 3. Please complete the entire application fm, marking any sections that do not apply to you as N/A (not applicable). Do not place your application in a folder. Incomplete applications will not be assessed. Submission Please submit the application fm and all suppting documentation by 4pm, Thursday 24 May By Mail Student Services William Angliss Institute PO Box 4052 MELBOURNE VIC 3001 In Person Student Services Building C, Level 1 (Melbourne Campus) Late submissions will not be accepted. Page 1 of 6

2 Personal Details Title: Mr Mrs Ms Dr Other Family name: Given name(s): Date of Birth: D D / M M / Y Y Y Y Gender: Male Female Other (please specify): Country of birth: Residential address Address: Suburb: State: Postcode: Telephone: ( ) Mobile: Mailing address (if different from above) Address: Suburb: State: Postcode: Are you currently enrolled as a William Angliss Institute student? Yes No What type of program are you currently enrolled in, intending to study, in the upcoming semester? Vocational Education & Training Certificate III IV Higher Education Bachel Degree Diploma Advanced Diploma Course Name: Campus: Melbourne Lilydale Sydney Will 2018 be the first time you have enrolled in a tertiary program (Vocational Education & Training Higher Education)? Yes No Page 2 of 6

3 Equity details Please refer to page 5 f evidence of suppting documentation sd Are you of Abiginal and/ Tres Strait Islander igin? No Yes-Abiginal Yes Tres Strait Islander... F persons of both Abiginal and Tres Strait Islander igin, mark both Yes boxes. sd1 Are you living with a disability, long-term medical illness mental health condition that impacts your study? No Yes... sd2 Have you already moved, are you moving, from a rural/regional/interstate area in der to study? No Yes If yes and i) you are planning on moving, indicate the date you intend to move to Melbourne (VIC students) Sydney (NSW students)... sd3 and the date you commenced your tertiary studies at William Angliss Institute OR ii) you have already moved, indicate the date you moved... sd4 To determine financial disadvantage Are you currently receiving one of the following Centrelink benefits f low income suppt?... sd5a No Low Income Health Care Card Youth Allowance Austudy/ABSTUDY Pension If no i) Are you a domestic student? No Yes... sd5b OR ii) Are you an international student? No Yes... sd5c Do you currently receive any scholarships (eg Centrelink, Government, other)? No Yes If yes, list the name of the scholarship(s), how much you receive and the frequency of payments. Name of Scholarship How much you receive Frequency of payment Other Circumstances Complete this section only if you are experiencing difficulties in your family, there are other circumstances previously not mentioned that prevent you from reaching your education potential. Please indicate if these circumstances are affecting your education, ability to study, access to educational facilities and resources, school attendance if there is anything else to consider when we assess your application. sd6 Page 3 of 6

4 Application infmation to submit In addition to the suppting documentation (page 5) requested throughout the application fm you are required to submit a separate typed document* (maximum 600 wds), addressing each of the following statements in the der provided: a. Why you have chosen to undertake your course of study and what your long-term career goals are b. Your academic perfmance and achievements in your studies c. How you intend to use the scholarship, including how it would enable you to complete your studies and achieve your employment goals. *If you are unable to provide a typed document, a legible hand written statement will be accepted. Declaration I have reviewed and completed my application and have: attached all additional suppting infmation selected a scholarship(s) that I am eligible f read and understood the terms and conditions of the scholarship application process (available at I (full name) declare that, to the best of my knowledge, the infmation supplied in this application is true and complete. I acknowledge that the provision of false infmation documentation the withholding of infmation documentation relating to my application may result in the cancellation of any scholarship by the Institute. I confirm that I have read and understood the infmation f applicants, and understand the conditions of the scholarships. I authise the Institute to obtain, where necessary, further infmation regarding this application from other relevant bodies. I understand that the scholarship process is competitive and that not all applicants who meet the eligibility criteria can be awarded a scholarship. I will verify my ongoing eligibility as required. Signature: Date: Privacy Statement The Institute is providing you with this notice because it has sought personal infmation about you. The Institute needs this infmation so that it can fully and properly assess your application in accdance with its policies and procedures. The infmation you supply on this fm and in any documentation supplementary to this application may be provided to scholarship selection authities. Personal Infmation collected and/ held by the Institute will only be used f the purpose f which it was collected otherwise in accdance with the Infmation Privacy Principles (IPPs) and in accdance with the Institute Privacy Policy (available at If you would like to request access to your personal infmation find out me about how the Institute respects your right to privacy, please contact (03) to be directed to the Institute s Privacy Officer via at governance@angliss.edu.au. Page 4 of 6

5 Suppting Documentation sd Circumstances SD1. I am of Abiginal and/ Tres Strait Islander igin SD2. I am studying with a disability, long-term illness mental health condition SD3. I am moving from a rural/regional interstate location to study SD4. I have already moved from a rural regional/interstate location in der to study SD5. I am financially disadvantaged A) I receive Australian Government benefits income suppt, from Centrelink, have a concession/ health care card. I have been low income tested. B) I don t receive Australian Government benefits f income suppt n do I have a low income concession / health care card. In addition to providing evidence of your income, if either of the below is relevant to you, you need to provide appropriate suppting documentation I live with my parent(s) with a partner and do not receive Australian Government benefits f income suppt I do not live with my parent(s) partner, but they financially suppt me Evidence required to provide --Confirmation of Abiginality fm completed in consultation with the Institute s Koi Liaison Officer ( ) --A detailed letter from your health care provider* --Evidence of Centrelink disability sickness benefit payments* --Proof of your current rural/regional/interstate address; eg: a copy of your bank statement* - Proof that shows your previous and current addresses and when you moved, eg: dated bank statements that show old and new addresses; rental agreement demonstrating when you moved in --your current Centrelink Health Care Card*, --your Centrelink Pensioner Concession Card*, --Centrelink Exceptional Circumstances Certificate*, --an income statement* from Centrelink that shows you are in receipt of low- income suppt payments f Austudy, ABSTUDY, Youth Allowance, Newstart Allowance a pension. The letter should show the type and amount of Centrelink payments you receive (excluding any non-income suppt such as Family Tax Benefit Part A B, Childcare Benefits, Carer Allowance and/ Parenting Payment)* A statement a) detailing your circumstances, including how they are affecting your education, and b) why you are not receiving Centrelink benefits. --your proof of income f the financial year i.e. Australian Taxation Office notice of assessment year ended 30 June. Your income must be below the Centrelink low income test in the financial year , --your last three pay slips, if applicable*, and a brief description of your living arrangements in including number of family members and what capacity if any you contribute to the family income --your parents partner s income f the financial year , e.g. Australian Taxation Office Notice of Assessment year ended 30 June, and --their last three consecutive pay slips* --a statement specifying their yearly weekly contributions to you on your behalf (e.g. rent, bills paid to a third party)*, and a brief description of what their living arrangements will be in 2018 including details of any other dependent children, their ages and whether there are any other tertiary students living at home, and --your parents partner s income f the financial year , e.g. Australian Taxation Office Notice of Assessment year ended 30 June, and your parents partner s last three consecutive pay slips* Page 5 of 6

6 C) I am an international student experiencing sht-term* financial difficulties SD6. I have other difficulties and/ special circumstances which impact my education A brief description of your current circumstance including any further suppting documents* --Your last three pay slips, if applicable*, --Your bank statement from the last three consecutive months*, and --A brief description of your current circumstance including any further suppting documents* If current circumstances are impacted by a sht-term medical condition, suppting documents should show a claim histy with your OSHC provider* and include a letter from your health care provider* --A copy of documentation to suppt statements in your application * The evidence you provide must not be me than three months old. Page 6 of 6