Important: Do Not Print This Document Or Complete in Hand-Writing . Type in Your Response

Important: Do not print this document or complete in hand-writing. Type in your response or select the relevant response provided. Save and submit the document as per instructions in Section 14.

Sport Scholarship Support levels vary and may include financial assistance, physiotherapy and massage services, strength and conditioning as well as facility access.All applications will be considered against criteria for each of the available Sport Scholarships for the year, applicants do not need to apply for a specific scholarship.

1. Personal Details
First Name: / Surname:
Date of Birth (dd-mm-yyyy): / Gender:
Postal Address:
Suburb: / State: / Postcode:
Preferred Email:
Home Telephone: / Mobile Telephone:
2. Academic Details (Prospective Students only):
Course Preference 1: / Semester 1 Status (full-time or part time):
Course Preference 2: / Semester 2 Status (full-time or part time):
Please indicate if you applied or intend to apply to study at the University of Melbourne via one of the following entry pathways:
Elite Athletes and Performer’s Entry Scheme Access Melbourne
Year 11/12 Special Consideration Graduate Access Melbourne
Non School Leaver Entry
3. Additional Information
Nominated Sport: / Position/Discipline/Event:
Secondary School attended for Year 12:
(including AUS State or Country for international applicants)
Are you of Aboriginal or Torres Strait Islander descent?
If you intend to apply for University of Melbourne Residential/College Accommodation for 2016, please indicate which college is your first preference:
How did you become aware of the University of Melbourne’s Elite Athlete Program?
4. Club Affiliation: Which club do you currently compete for?
Club:
If not currently competing for Melbourne University, are you prepared to transfer clubs?.
Melbourne University clubs may provide additional scholarship support.
5. Personal Best Times/Distances/Scores over the past 24 months (where applicable)
Event/Discipline
eg. 100m / PB
eg. 10.37 secs / Competition
eg. Victorian Championships / Date Achieved
(dd-mm-yyyy)
6. State/National Rankings over the past 24 months (where applicable) / Date Achieved
(dd-mm-yyyy)
State Ranking eg. 1st U/23 Single Scull:
National Ranking eg. 2nd Open 400m
7. Representative Honours over the past 24 months (where applicable) / Date Achieved
(dd-mm-yyyy)
Regional Level eg. Western Zone Schools
State Level eg. Vic U/21 team:
National Level eg. Australian Olympic team
8. Other significant SportingAchievements over the past 24 months / Date Achieved
(dd-mm-yyyy)
9. Have you been awarded a Scholarship at a State/National Institute or Academy of Sport in the past 24 months?eg VIS 2016 / Year Achieved
If Yes, Name of Institute/Academy:
10. References
Please provide the names and contact details of two referees who can testify as to your sporting achievements
Referee 1: / Relationship:
Phone Contact: / Email:
Referee 2: / Relationship:
Phone Contact: / Email:
11. Personal Statement
Please provide a succinct statement outlining why a Melbourne University Sport Scholarship will assist you in your sporting and academic endeavours.
Receiving a Melbourne University Sport Scholarship will:
12. Acknowledgement and Privacy Statement
I acknowledge that the information provided by me (including any attachments) in this application is true and accurate. I understand that Melbourne University Sport reserves the right to amend or terminate the awarding of a scholarship should information provided in this application be false and incorrect. I also understand that the information provided by me is collected, stored and destroyed in accordance with the University of Melbourne Privacy Policy.
I acknowledge and submit my applicationDate:
13. To Submit Application

Simply save the application with file name: Surnameeg. Smith

2. Email the document to .
Stage 1 Sport Scholarship applications close at 5.00pm Friday 11thNovember 2016
14. Further Information
Melbourne University Sport offers a range of scholarships and grants under its Elite Athlete Program. Applicants should refer to the criteria for each scholarship/grant as outlined in the Sport Scholarship Guidelines available at All applications will be considered against criteria for each of the available Sport Scholarships and/or Grants for the year – hence, applicants do not need to apply for a specific scholarship or grant.
All Sport Scholarship and Elite Athlete Program queries should be directed to the Elite Athlete Program Coordinator via P: 03 9035 3626 or E: