DON DUNSTAN FOUNDATION LEN KING SCHOLARSHIP

2018 APPLICATION FORM

Please type your information

APPLICANT (STUDENT) DETAILS

Title / Family Name / Given Names

Home Address

Street
Suburb / Post Code
Telephone Number / Fax Number
Email Address

Student’s address during term (if different from above)

Street
Suburb / Post Code
Telephone Number / Fax Number
Email Address
Date of Birth
Day / Month / Year
Number of Children / Age of Children

Are your children living with you? YES / NO

Delete n/a

DETAILS of PARENT(S) /GUARDIAN(S) (if under 25)

and/or PARTNER (if de facto/ married)

Mother
Title / Family Name / Given Names
Father
Title / Family Name / Given Names
Partner
Title / Family Name / Given Names


Occupations of parent(s)/guardian(s)/partner

Mother:
Father:
Partner:

Parents’ Home Address (if not same as student’s)

Street
Suburb / Post Code
Telephone Number / Fax Number
Email Address

COURSE OF STUDY (please also complete the personal statement on page 4)

Name of University
Name of Course
Length of Course / years
Date of commencement / Expected completion date
Study Details / FULL TIME/ PART-TIME / ON CAMPUS/ EXTERNAL
Delete n/a

EMPLOYMENT AND INCOME STATUS

Do you receive a Centrelink payment? / YES / NO
If YES, please attach Centrelink Income Statement. / Delete n/a
Do you have a Health Care Card? / YES / NO
If YES, please attach a photocopy of your HCC. / Delete n/a
Are you currently employed? YES / NO / YES / NO
If YES, please attach copies of your two most recent payslips. / Delete n/a

EDUCATION HISTORY

Secondary Education

School Attended / Number of Years
Highest level completed at secondary school / Age at time of leaving school

Tertiary/Further Education

Have you previously attended a University/College or TAFE? / YES / NO
If YES, please give details. / Delete n/a
Course of Study / Year Completed / Level Reached

OTHER ASSISTANCE, SCHOLARSHIPS, PRIZES OR AWARDS

Have you received scholarships or financial assistance for your education in the past? / YES / NO
If YIf YES, please give details. (Field will expand as you type) / Delete n/a
Have you obtained any prizes, scholarships or other awards for your study next year? / YES / NO
If YES, please give details. (Field will expand as you type) / Delete n/a
Have you made application (applied) for any prizes, scholarships or other awards, whose outcome has not yet been decided, for your study next year? / YES / NO
If YES, please give details. (Field will expand as you type) / Delete n/a

REFEREES

Give the name, address and position of two referees who may be contacted in connection with this application.

Referee 1
Title / Given Name / Surname
Position
Phone number / Email
Referee 2
Title / Given Name / Surname
Position
Phone number / Email

PERSONAL STATEMENTS

(Fields will expand as you type)

State your reasons for applying for the Dunstan Foundation Len King Scholarship.

Please include details of how you would spend the funds.

State your reasons for your choice of degree.

Please include any earlier life experiences which may have influenced your decision, as well as any current influences.

Please provide more information on your interest/experience in social justice issues.

Social justice issues are issues of disadvantage and inequity due to the distribution of wealth, power and privilege, and lack of access to opportunity, within a given society and globally.

How would you see your success in this study making a difference to social justice issues?

NOTE TO APPLICANTS

·  Applications close on 20 January 2018.

·  Applications and attached documents should be submitted by email.

HAVE YOU PROVIDED THE FOLLOWING?

1.  A completed Application Form

2.  Proof of Income Documents (Page 2)

3.  Names of two referees (Page 3)

4.  Completed Personal Statement (Page 4).

NOTE: Documentation relating to the financial circumstances of family/partner/children is not required now, but may be requested at a later stage.

PRIVACY STATEMENT

Please note: The Wyatt Trust will undertake administration of the Dunstan Foundation Len King Scholarship on behalf of the Don Dunstan Foundation.

Personal Information

When you apply to The Wyatt Trust for a scholarship you will be asked to give personal information so that The Wyatt Trust can ascertain if you are eligible and arrange payment of the scholarship, if approved.

Confidentiality and Security

The information obtained is not disclosed to any other person, without your consent. The Wyatt Trust and the Don Dunstan Foundation staff members are trained to maintain professional standards of confidentiality in their contact with applicants and others who are involved in the payment of scholarships. The information obtained is kept securely at the office of The Wyatt Trust and eventually destroyed.

Access

You may ask to view the personal information held by The Wyatt Trust regarding you. You will be required to show proof of personal identity and state your reason for your need for access before you may be provided with a photocopy of the relevant pages of the application form. Wyatt will not disclose to you information regarding any other person during this process.

*  EMAIL completed application by 20 JANUARY 2018 to

Tamsin Anspach

The Don Dunstan Foundation

08 8313 3364

2018 Dunstan Foundation Len King Scholarship Application Form 5