2016Scholarships and Bursary Application Form

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Applicant’s Details

Family Name:Given Name:
Address:

Email:

Phone (H): (W): (M):

I am an Australian Citizen OR I am a Permanent Resident of Australia

(Documentary evidence may be required.)

Note: If you are not an Australian Citizen or a Permanent Resident you may not apply for the scholarships. You may apply for the Foundation Bursary.

I wish to apply for the following Graduate Women (WA) Bursary or Scholarships:

(Please tick)

Graduate Women (WA) Foundation Bursary – Any discipline

Graduate Women (WA) Mary Walters Scholarship - Science

Graduate Women (WA) Mary and Elsie Stevens Scholarship – Mathematics or Science

Graduate Women (WA) Joyce Riley Scholarship– Humanities or Social Sciences

 Graduate Women (WA) Jillian Bradshaw Scholarship– Humanities

Academic Record

First Degree:

University:

Degree:Date:

Attach a certified copy of academic course record

Other Academic Qualifications:

Institution:

Qualification:Date:

Attach a certified copyof academic course record

Current Enrolment:

University:

Degree:

Date Commenced:Estimated Date of Completion:

Attach proof

List any other academic achievements such as publications and prizes:

List all other financial awards of which you are in receipt or for which you have applied:

Detailed information

Provide a detailed overview of your research project or course: (Maximum 800 words)

Details of specific academic or professional purpose for which the award is sought: (Maximum 400 words)

Provide full details of the specific purpose for which this award will be used and how it will enhance your research or aid your completion

Explain any possible applications of your research: (Maximum 100 words)

Sum of money requested:

Itemised budget of how the money will be spent:

Bursaries and scholarships will not be awarded for the purchase of computers or for professional editing.Travel and accommodation to be

costed at cheapest available rate.

Bursary Applicants Only:

Describe any special circumstances that necessitate an award for completion of your project(Maximum 300 words)

Referees: Applicants must list two academic referees.

NOTE: Please make sure your referees submit their reports direct to Graduate Women (WA) before the closing date.

One of your referees must be your principal supervisor and the other must be an academic who has knowledge of

your project.

1) Name:Institution:

Position:

Phone:

Email:

2) Name:Institution:

Position:

Phone:

Email:

Signed: ………………………………………………………… Date:

PLEASE NOTE:

List all the documents attached to this application.

This application must be completed fully.Please submit your completed application by emailing all documents to Graduate Women (WA) Inc at .

Graduate Women (WA) Application Form 2016Page 1 of 4