Mount Lawley Teachers College Memorial Award

Application Form

All questions on the application form must be completed and ALL supporting documentation including written statement must be submitted as part of application as indicated otherwise the application may

not be considered.

Applicant Details
Student No. / Click here to enter text.
First Name: / Click here to enter text. / Surname: / Click here to enter text.
Contact PH: / Click here to enter text. / Email: / Click here to enter text.
Please ensure that your correspondence address details are updated on SIMO
1.  Are you an Australian Citizen or an Australian Permanent Resident? / ☐ / Yes
☐ / No – you are ineligible for this scholarship
2.  Are you currently completing you honours in School of Science course? / ☐ / Yes
☐ / No – you are ineligible for this scholarship
3.  Which School of Science honours course are you currently enrolled in?
Course Code / Click here to enter text. / Course Name / Click here to enter text.
4.  Written Summary
Please attach a written summary (of no more than 1 side x A4 page) to this application form indicating the following; -
·  purpose, nature and significance of your proposed research area
Checklist – Please tick to indicate that you have attached the following supporting documentation (where applicable) to this application form. Failure to provide supporting documentation may affect you receiving a scholarship offer. Please copy /scan
☐ / Evidence of Australian Citizenship or Permanent Residency status
☐ / Written summary
☐ / Copy of results of your previous 3 year degree if not studied at ECU
Important: Giving false or misleading information is a serious offence under the Criminal Code Act 1995
Declaration: I declare that the information I have supplied on this form and in associated attachments is complete, true and correct, to the best of my knowledge. I understand that if any information is found to be incorrect, my application may be cancelled.
Signature Click here to enter text.
Date Click here to enter a date.

Completed application form should be forwarded to:

ECU Scholarships Office

Edith Cowan University

Joondalup Campus

270 Joondalup Drive

Joondalup WA 6027

Email:

If you wish to deliver by hand, please visit any campus Student Central and request they forward to ECU Scholarships Office prior to closing date.