If you have any questions or require assistance with this form, please contact Student Central, s Team 6773 2000. Applicant Details First Name * : Last Name * : Date of Birth * : Student Number: Home Address * : Town/City * : State * : Postcode * : Postal Address (If different from above): Town/City * : State * : Postcode * : Telephone No * : Mobile No: Email address (your personal email) * : Status Are you an Australian citizen? (yes/no): Are you an Aboriginal or Torres Strait Islander? (yes/no): Are you an International student? (yes/no): Are you a current student of UNE? (yes/no): Are you a non-school leaver? (yes/no): Is your home address in a regional or remote area as defined by: www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/locator Details Please list the scholarship/s you are applying for: Page 1 of 5
Selection Criteria Academic Details Which degree/award are you currently studying or applying for at UNE? What year of your course will you be enrolled in 2018? (eg First, Second, Third) What is your area of study? Mode of Study: Full time Part time On campus Off campus What is your current GPA? Are you entering into an honours year? (yes/no) What is your thesis area? (If applicable) Complete the following sections that are relevant to the s that you are applying for only. NB. Please read the relevant Terms & Conditions before completing. If you are applying for a Current or Non School Leaver, you may need to provide supporting documentation as per the selection criteria of the scholarship you are applying for. The applicant is to provide a 200 word statement describing their career aspiration and how their studies will help achieve these. The applicant will be required to demonstrate and attach evidence to support financial need which may be: 1) a copy of a Centrelink statement 2)their parent s/parents Income Tax Return/s (if dependent) or 3) their own Income Tax Return (if independent) and 4) a letter from an authorised person (eg family doctor, accountant). Page 2 of 5
The applicant to provide a brief statement describing how they would benefit from the scholarship and how they would use the funds if successful. The applicant will be required to demonstrate contribution to University sporting, cultural and/or community activities. Rural Background: the applicant will be required to provide information on their rural background that is relevant to the. Page 3 of 5
Additional Information: please provide any additional information that may be relevant to your application. Referee/s Details: Please provide details of your referee who will support your application if required by commenting on (a) your personal attributes and (b) your involvement and leadership at university and in community activities: Referee's Name: Organisation: Position: Telephone: Email: Academic Referee/s Details: Please provide details of your academic referee who will support your application if required. This person should be a senior academic conversant with your most recent academic studies: Referee's Name: Position: Telephone: School: Email: Page 4 of 5
Documents Required Provide any other documentation as per the selection criteria/document required of the scholarship for which you are applying. Attach evidence to support financial need, which may be: - a copy of a Centrelink statement; or - your parent s/parents Income Tax Return/s (if dependent); or - your own Income Tax Return (if independent); or - a letter from an authorised person (eg minister of religion, accountant) that comments on the applicant s financial circumstances. Academic Referee s Report (please use this template) Referee's Report from a person commenting on your personal attributes and on your involvement and leadership in university and community activities (please use this template) Student Declaration I declare that all the information submitted is correct and complete. I give permission for the s Officer to access my current academic record for the information of the Selection Committee. I acknowledge that the University may use some information from this application for publicity purposes and that my name may be listed as a successful candidate in the University of New England publications. Applicant Name: Applicant Signature: Date: Student Checklist Is your Student Number written on every page of this application? Have all relevant sections of the form been completed? Have you included all supplementary documentation or statements required? Have you signed the declaration? NOTE: Missing documents may mean your application is not processed on time. Privacy Statement The information provided on this application form is being collected to assess your application for a UNE undergraduate scholarship. This information will be processed by the s Officer and supplied to the s Committee. If you are offered a scholarship, this information, together with any additional information provided to support your application will be retained for administrative purposes. The supply of this information by you is voluntary, however if you do not supply all the requested information we may not be able to assess your application. You have the right to access and/or correct any of your personal information held by the University, subject to the reasonable convenience of the University. UNE s privacy policy can be found on the web at http://www.une.edu.au/privacy or can be provided on request. Submitting Your Application Please click the SUBMIT button to open a new email this will be automatically addressed to the UNE scholarships team at: scholarships@une.edu.au Check the application appears as an attachment in the email. Ensure any supplementary documents are attached. Send the application. Page 5 of 5