Hard Copy Application Form PDF File,

Hard Copy Application Form PDF File,
Edith Cowan University
Student Services Centre - Scholarships
Indigenous Commonwealth Scholarships
Application Form
First Name
Surname
Student ID
Contact Telephone Number
Email Address: (student email preferred)
An Australian Aboriginal or Torres Strait Islander is a person of Australian Aboriginal or Torres Strait Islander
descent, who identifies as an Australian Aboriginal or Torres Strait Islander, and is accepted as such by the
community with which he or she lives or has lived.
Are you of Australian Aboriginal and/or Torres Strait Islander descent?
Yes
No
If you would find it hard to provide evidence of community acceptance please detail why:
Are you enrolled in a course at ECU this semester?
No (But I am intending to enrol soon)
Yes
Course Code: _____________________
No (But I have applied for a course)
Please provide your ECU course details.
Course Code:
Course Title:
These are the level/type of course you would need to be enrolled in
to be eligible for a Commonwealth Scholarship.
Please confirm what you are/will be studying
Enabling/Bridging/Preparation
Undergraduate Bachelor Degree
Honours (Undergraduate Bachelor)
Postgraduate Diploma in Education
What ECU campus will you be studying
at?
Joondalup
Mount Lawley
Bunbury
External /online (off campus)
What will your study mode be?
Full-time
Part-time
Have you previously received or are you currently receiving any of the following Scholarships?
Indigenous Payment (CAS-IP)
Commonwealth Education Costs (CECS.ICECS,CECS-IE)
Commonwealth Accommodation CAS,ICAS,CAS-IE)
Relocation (via Centrelink)
Other/s
Student Start Up (via Centrelink )
______________________________________________
Important: Please complete a Centrelink Confirmation eServices (CCeS) Customer Consent Record and
attach to this document to complete your application. (form available on the ECU web site)
If you do not receive a Centrelink Allowance what is your combined household income?
This figure MUST include all monies received by your household, including partners/adult children etc.
We may ask for supporting documentation such as income tax assessment notice and / or pay slips.
$ _______________ per month
$____________________ for 2014/2015
Do you have any children/dependants?
Yes, How many? ___
No
Do you have significant carer responsibilities?
Yes
No
Scholarships Telephone: +61 8 6304 3636
Fax: +61 8 6304 2088 Email: [email protected]
Edith Cowan University
Student Services Centre - Scholarships
How many people (including children)
normally live in your household? ___
Do you have a disability or an ongoing illness?
Yes
No
Are you registered with the ECU Equity, Diversity and
Disability Office?
Yes
No
Please provide details of the address where you will be living during semester time
Suburb _____________________________________ Postcode _____________
Have you /will you have to relocate from a rural, regional or remote area for the purpose of study?
No (go to next question)
Yes, Please provide Suburb and postcode of rural, regional or remote address:
Suburb ____________________________
Postcode_________
How long did you reside at your rural address? ______ Years ______ Months
Have you already completed the requirements of a course of study equivalent to or higher than, an Australian
bachelor’s award?
No
Yes- please provide details:
Please provide information relating to your circumstances, either past or present which have had a significant
impact on your life and capacity to give time and attention to your studies. (Any additional information can be
attached on a separate A4 page)
Please provide a statement outlining your personal goals or what you hope to achieve upon completion of
your studies and how this scholarship will help you achieve these goals. (Any additional information can be
attached on a separate A4 page)
Important: Giving false or misleading information is a serious offence under the Criminal Code Act 1995
Declaration: I declare that the information I have supplied on this form and in associated attachments is
complete, true and correct, to the best of my knowledge. I understand that if any information is found to be
incorrect, my application may be cancelled.
___________________________________________
Signature
Scholarships Telephone: +61 8 6304 3636
__________________
Date
Fax: +61 8 6304 2088 Email: [email protected]
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