Jack Baxter Middleton Memorial Scholarship

2018 Application Form

Section 1: PERSONAL DETAILS AND ACADEMIC RECORD

Student Number / Male Female Other
Mr/ Miss/ Ms / First name: / Family name:
Postal Address:
Suburb: / State: / Postcode:
Telephone (home) / Mobile:
QUT Student email address:
Where did you find out about this Scholarship? / Email Website Lecturer Another Student
Other: (Please give details ) ______

Section 2: ACADEMIC RECORD

What course are you are currently studying at QUT? / Course: / Major:
Please indicate which course and major you will be enrolled in during 2018? / Bachelor of Engineering (Honours) (Electrical)
Bachelor of Engineering (Honours) (Electrical and Aerospace)
Bachelor of Engineering (Honours) (Computer and Software Systems)
Bachelor of Engineering (Honours) (Mechatronics)
OR
Bachelor of Business/Bachelor of Engineering (Honours)
Engineering major:
Bachelor of Engineering (Honours)/Bachelor of Information Technology
Engineering major:
Bachelor of Engineering (Honours)/Bachelor of Mathematics
Engineering major:
Bachelor of Engineering (Honours)/Bachelor of Science
Engineering major:
Please note that only students who will be enrolled in 2018 in their second year of full-time study of one of the Engineering courses listed above are eligible to apply for this scholarship.
What is your QUT GPA? / Please attach a copy of your academic record from QUT Virtual. You must have a GPA of at least 5.5 to be eligible to apply.
Other / Please indicate if you have any of the following prior experience/qualifications:
experience in an electrical or related trade
electrical or related VET sector qualifications

Section 3: SCHOLARSHIP RESPONSE QUESTIONS

Please attach your answers to the following questions. (Suggested length, half a page per question).

1.  Briefly outline your future career aspirations and explain your motivations for studying your chosen course and major.

2.  Give an example of where you have demonstrated leadership qualities in the context of the university environment.

3.  Describe an experience where you have participated in and taken on a leadership role in a community activity.

4.  If applicable, please outline your prior experience in an electrical trade, VET sector qualification or any other associated work experience.

Section 4: PROFESSIONAL QUALIFICATIONS & EMPLOYMENT HISTORY

Please attach a copy of your resume

Detail your professional qualifications and employment history, include details of paid employment and work experience. If you have any previous experience or qualifications in electrical trades or similar, we would like to hear about that in detail.

Please provide details of any special awards, prizes or other achievements you have accomplished at QUT as well as involvement in extracurricular activities. This may involve your participation in the arts, cultural and sporting activities; youth and community groups; your interests or hobbies outside of your educational pursuits. Please provide details of any leadership roles you have undertaken in your extra-curricular activities.

Section 5: DECLARATION & SUPPORTING EVIDENCE

A. DECLARATION

I declare that, to the best of my knowledge and belief, all the information I have provided is true and correct to the best of my knowledge. I understand that the submission of false information in my application will result in the disqualification of my application.

I have read and understood the conditions of this scholarship and have included the required documentary evidence (see checklist below).

I agree to assist with promotion of the scholarship through participation at Faculty promotional/recruitment events if required.

Signature: ______Date: ______

Section 5 (continued)

B. TAXATION

You are encouraged to make your own enquiries about the effect of such a scholarship on your tax obligations or any government benefits you are currently receiving or may apply for in the future. Although QUT does not take any tax off the scholarship amount, QUT is not authorised to deem this scholarship tax exempt. Ultimate determination regarding the tax status of the scholarship will be made by the Australian Taxation Office. Please retain this statement with your tax documentation. Refer to www.ato.gov.au/individuals for further information.

C. PRIVACY DECLARATION

QUT collects the personal information on this form to assess your scholarship/bursary application and for other University purposes upon enrolment. The collection is authorised under the QUT Student Rules. Information explaining how QUT manages students' personal information and our practices for disclosure can be found at www.governance.qut.edu.au/compliance/privacy/.

D. CHECKLIST

Addressed all the sections outlined on the application form.

Attached copies of tertiary academic transcripts (copy of QUT Virtual academic history is sufficient).

Attached copies of previous qualifications in electrical trades or similar (if applicable).

Attached supporting documentation relevant to the application.

Attached your resume.

Completed and attached your responses to the questions in Section 3.

Read and understood the conditions.

Signed the Declaration (Section 5A).

CLOSING DATE FOR APPLICATIONS 5.00pm, Sunday, 26 November, 2017

By Email to Subject: Jack Baxter Middleton Scholarship Application

2018 Jack Baxter Middleton Scholarship Application form 1 | Page