Commonwealth Scholarships Program for South Australia
Easy Access Application Form – Round 1 2017
Instructions
Some inputs on this form are mandatory. The required fields are indicated by an *(asterisk).
Using this accessible form
This form is designed to assist those using screen readers or for people without consistent internet access. Please enter your responses next to or under the information requested. If there are multiple choice responses, please bold your selection.
Data collected from your form will be manually entered by our team onto our online application website.
Application Process
Please complete this form and email along with supporting documents to by 11:59pm (ACDT), Wednesday 25 October 2017. If you have any questions please contact 08 8364 8572.
You will be advised in writing of the outcome of your application. If you are unsuccessful we will notify you in writing following the notification of outcomes to all successful applicants. Common reasons why an applicant was not successful will be hosted on the Department’s website. Individual feedback can be sought from the Scholarship Program Coordinator.
Privacy Statement
Scope Global (the Scholarship Support Contractor to the Australian Government) is bound by the Australian Privacy Principles as set out in the Privacy Act 1988 (the Act).
Scope Global complies with the Act in the collection, handling use and disclosure of personal information. We will collect and hold personal information only if the information is necessary for one or more of our functions or activities and with consent or where we are authorised or required to do so by law.
We will be collecting personal information about scholarship applicants and recipients, which may include:
· name, gender, age and date of birth;
· email address and social media account details;
· residential and postal address and telephone numbers;
· bank account or financial details;
· proposed study stream, industry, level of study and mode of study
· details of other support you receive
· information received as part of the application process if you are applying for a scholarship;
· academic records, transcripts, enrolment and assessment details; and
· other considerations such as listed in the disclosure information section.
If you disclose that you are a person with a disability as part of your application process, this information is deemed as health information under the Act and will be treated sensitively and in accordance with the Act.
The information in this application form is collected to assist Scope Global to determine your suitability for selection under the Program. In addition, Scope Global collects, holds, uses and discloses personal information to enable us to:
· assess an applicant’s eligibility;
· resolve a complaint;
· provide further information about a program or project;
· administer our programs and projects;
· work with government agencies and other relevant stakeholders to implement and run our programs and projects;
· record all relevant interactions with an individual if required; and
· for other purposes related to any of the above.
Your personal information will be used and accessed by Scope Global, the Department and any necessary third parties who assist us to implement, provide, manage and administer our Programs, including third party contractors and service providers, our insurers and any person with a lawful entitlement to obtain the information. Applicants are required to consent to use and disclosure of personal information for the purposes of the Program. Disclosure will include disclosure by the Scholarship Support Contractor (Scope Global) to the Department for the purpose of assessing applications and may include publication of personal information of successful applicants.
Your information may also be shared with the Australian Government who may use and disclose information about Scholarship applicants and Scholarship recipients under the Program in any other Australian Government business or function. This includes giving information to the Australian Taxation Office for compliance purposes.
If you do not give us the information we seek, we may be limited in our ability to assess your application against the Program Guidelines and/or may not be able to provide an individual with the services requested, including access to a particular program or project.
Our privacy policy contains further information about the type of information we hold and how we manage your information, including how you can, subject to some exemptions, access personal and sensitive information about you that we hold and request that it be corrected. It also sets out how you can complain about any alleged breaches of the APPs and how we will deal with any complaints. A full copy of Scope Global’s Privacy Policy is available on the website by clicking here. Further Privacy information is also available under Section 14.3 of the Program Guidelines.
Eligibility Criteria
You must answer yes to all the below six criteria to apply for this scholarship program. Multiple choice responses are below the criteria.
1. Are you an Australian Citizen or Permanent Resident?
2. Are you eligible to undertake an Approved Program of Study? (The term ‘eligible’ means you must be able to gain entry in to the qualification you are intending to undertake, having met any academic prerequisites set by the education and training provider).
3. Will you be aged 15 – 64 years at commencement of study?
4. Are you living in, or will you relocate to, South Australia for the duration of the Scholarship?
5. Are you willing and able to participate in an internship (where applicable)? A critical component of the Program is the Scholars’ participation in paid internship, in which Scholars will undertake an internship for a period equivalent to 20 business days. The internship will be in addition to the Approved Program of Study. See Program Guidelines Sections 4.7 & 8.3 for more information. If a program of study already includes a mandatory work placement (e.g. apprenticeships or clinical work placements), you will not be required to participate in an internship.
6. Do you intend to enter the workforce or accept employment in South Australia at the end of the course of study or training?
Yes, I meet all criteria.
No, I do not meet all criteria.
If you do not meet all the criteria, you are not eligible to apply at this time. If you have any questions or concerns regarding the criteria and your ability to apply, please contact us to discuss on or 08 8364 8572.
Personal Information
Name
*First Name:
Middle Name (optional):
*Last Name (as per your supporting documentation):
Preferred Name:
*Date of Birth:
*What is your Gender?
Male
Female
X – Indeterminate, Unspecified, Intersex
Disclosure Information
Disclosure is a personal choice and relates to section 6.1 of the Program Guidelines. This information may factor into the selection process. Your disclosure information remains confidential with the Scholarships Support Contractor and Department of Education and Training so that they are aware of the nature of your disclosure and can best assess the types of reasonable adjustments and support that would be appropriate for you, if applicable or required.
*Do you identify as Aboriginal or Torres Strait Islander?
No
Yes
Prefer not to disclose
*Do you identify as a person with a disability?
No
Yes
Prefer not to disclose
*What is your current employment status?
Full time employment
Part time/ casual employment
Not currently employed
Prefer not to disclose
*Have you been retrenched? (e.g. following steelworks or manufacturing closures)
No
Yes
Prefer not to disclose
If yes, please provide details:
Are you a current or former (within the past five years) automotive industry worker?
No
Yes, current automotive industry worker
Yes, former automotive industry worker
Prefer not to disclose
Are you in receipt of income support from the Australian Government?
No
Yes
Prefer not to disclose
If yes, please specify:
Contact Information
Residential Address
*Address Line 1:
Address Line 2:
*Town/City/Suburb:
*State/Province:
*Post Code:
Country:
Postal Address (leave blank if same as above)
Address Line 1:
Address Line 2:
Town/City/Suburb:
State/Province:
Post Code:
Country:
Email and phone
Primary email address:
Secondary email address:
Primary phone number:
Secondary phone number:
Please indicate your preferred method of telephone contact:
Proposed Program of Study Information
In this section, you will need to outline information about the study or training you intend to undertake through the scholarship. You can apply for a maximum of three programs of study and will need to complete a separate application form for each program of study.
*Name of Proposed Program of Study. Please ensure you use the exact wording used on official documentation/course website:
*Name of proposed Education or Training Provider. Please ensure you use the exact wording used on official documentation/provider’s website:
Which Stream are you applying under? Depending on your Approved Program of
Study and intended industry of employment, your application will be for either Stream 1, 2 or 3. Click here to access the Program Guidelines and refer to Section 4.2 “Eligible
Programs of Study” for information about which stream you should select.
Stream 1 – Defence Industry, including naval ship building
Stream 2 - Advanced manufacturing, health services and medical research, tourism and
hospitality, wine and food (including beverages), and energy and resources. Applications will also be accepted from students who intend to study in a field that is relevant to, and are currently employed by, businesses with innovative practices that result in economic growth.
Stream 3 – South Australian State based skills needs. Any occupation listed on the Australian Government Department of Employment’s Skills Shortage List for South Australia will be eligible for a Scholarship. This list is available here. (Please note that occupations assessed at the national level only are not eligible under this stream.)
If stream 2, please write your industry based on the five options listed under stream 2, or write ‘innovative business’
If stream 3, please write the exact occupation from the Skills Shortage List for South Australia
*Mode of Study:
Part-time
Full-time
*Level of Study.
Level 3 - Certificate III
Level 4 – Certificate IV
Level 5 - Diploma
Level 6 - Advanced Diploma or Associate Degree
Level 7 - Bachelor Degree
Level 8 - Bachelor Honours Degree or Graduate Diploma
Level 9 - Master Degree
Level 10 - Doctoral Degree
*Study Start Date (eg. first day of first semester):
*Study End Date (eg. last day of final semester. If exact date is not available, be as accurate as possible):
*Does your program of study include a mandatory work placement component?
No
Yes
Unsure
Selection Criteria
Responses to the selection criteria should not exceed 450 words each.
*Criteria 1: Alignment with priority industries. 60% weighting. Describe how your program of study provides a pathway to employment in one or more of South Australia’s priority industries. Refer to Section 4.2 of the Program Guidelines to assist with your response:
*Criteria 2: Capacity to benefit. 40% weighting. Outline your commitment to complete your study or training and internship, how a Scholarship will assist you to complete your study and your career goals:
*Supporting Documents
The following supporting documents should be attached to your email application, along with this completed form. If you are having difficulties with any of the supporting document requirements, please contact us on 08 8364 8572 or to ensure there is no impediment to apply.
1. Evidence of Australian Citizenship or Permanent Residence for example one of the following:
o A copy of your Citizenship / Dual Citizenship Certificate;
o A copy of your current Passport (photo identification page);
o A copy of your Birth Certificate; or
o A copy of your Visa label or a Visa Entitlement Verification Online (VEVO) check.
2. Evidence of eligibility to undertake a Proposed Program of Study for example one of the following:
o Copy of Admission letter or confirmation of enrolment from education and training provider into intended or current program of study;
o Copy of Provisional offer from Approved Provider for intended Program of
Study; or
o Copy of Proof of application to Approved Provider for intended Program of Study (for example, a Letter of Offer; an application to SATAC; a copy of your application and an email confirming submission).
3. Evidence of current residency in South Australia (if applicable) for example one of the following:
o Copy of current driver’s license;
o Copy of recent utility bill
Declaration statement
Privacy
I understand that Scope Global is collecting my personal information to enable it to assess and process this application and for the purposes described in the application process. I understand that without this information, Scope Global will not be able to assess and/or process this application.
I also understand that my personal information will be disclosed by Scope Global (the Scholarship Support Contractor) to necessary third parties such as the Department for the purpose of assessing my application and this disclosure may include publication of personal information if I am successful.
I am aware that my personal information may be shared with the Australian Government who may use and disclose this information under the Program in any other Australian Government business or function including giving information to the Australian Taxation Office for compliance purposes.
I consent to my personal information being used and disclosed to the third parties and for the purposes described and notified to me in the application form.
I confirm that I have read, understand and accept the information provided in the Commonwealth Scholarships Program for South Australia Program Guidelines, including Section 14.3 regarding Privacy, Confidentiality and Protection of Personal information and Scope Global’s Privacy Policy.
Conflict of Interest
I must inform Scope Global of any real or perceived conflict of interest if I have a professional, commercial or personal relationship with a party who is able to influence the application selection process
If, during the Application process a real or perceived conflict of interest arises, I must notify Scope Global immediately in writing and take such steps as Scope Global may reasonably require to resolve or otherwise deal with the real or perceived conflict.
Under 18 Applicants
I understand that if my application is successful, a parent or authorised guardian will sign the Scholarship Agreement on my behalf.
I declare that the statements made in the attached application are true, complete and correct.
Agree
Disagree