Order of Australia Association FoundationScholarship

2015Scholarship Application Form

Applicants must download this application form, fully complete and sign. The Western Sydney University application form must also be completed. This form can be attached within the attachments section of the University application form.

The Order of Australia Association Foundation
2015 Scholarship
Application Form

Please note: All relevant sections of this form must be completed and appended with supporting documentation. Please do not submit original documents. The University cannot return any supplied documentation.

1.1. Personal details
Title / Student number
Family name
Given name(s)
Date of Birth
Citizenship status / Are you an Australian citizen? (please tick) : Yes No
Semester address details: / Address:
Postcode:
Phone:
Permanent home address (if different from above) / Address:
Postcode:
Phone:
Mobile telephone
number
Email (if read daily)
Do you hold any other prize, scholarship or financial award currently? / Yes No
If yes, please provide details: / Name of award: Duration:
Awarding body: Estimated annual payment:
1.2. Academic details
Current program details / Name of program (eg: BE)
Status / Full-time internal student (on campus)
Full-time external student
(Please note: Applicants must be full-time, internal students at the University to be eligible for this Scholarship)
Have you already completed a degree? / Yes / No
In which year did you complete year 12? / Name of yr 12 school
In which year did you commence your tertiary study?

This Scholarship is highly competitive. The following information is essential and must be provided if your application is to be considered.

1.3. High academic achievement
Please provide appropriate information: / Other evidence of high academic achievement, eg TE Score
(Please specify):
1.4. Financial hardship
Please indicate the type of documentation attached to your application.
Please note: a healthcare card does not necessarily indicate financial disadvantage. You must provide additional evidence.
If you do not receive Centrelink benefits you must provide evidence which clearly supports your case for consideration. / Centrelink (Youth Allowance) entitlement and rate of payment: $
Other Centrelink payments
(Please indicate payment type and fortnightly amount): $
Australian Taxation Office Assessment Notice
(if relying on family tax benefits as indication of financial hardship).
Other evidence of low income
(Please specify):
Are you in receipt of any other income (eg part time work, family support):
Yes No
If yes, please specify and provide approximate income per fortnight:
Amount of HECS debt already accumulated and expected in the future
$………………
1.5. Community Involvement/leadership initiative
Please provide evidence of demonstrated qualities of leadership, initiative and willingness to become involved in community affairs. This may include letters or certificates from local community or sporting groups attesting to your involvement and/or achievements. You should also provide a brief cv of no more than 3 pages which also includes the name and contact details of a referee who can attest to your achievements. / Describe current and past activities and achievements and how you have you been active in community affairs:
1.6 Career development
The Order of Australia Association Foundation Scholarship sponsored with the Western Sydney University aims to assist the awardee in their career development.
Please provide a statement describing your career goals and explain how the Scholarship would assist you to achieve them:
I will be available if required for interview 25 November 2015
Declaration
I declare that the information supplied on this form and in accompanying documents and statements is complete and correct to the best of my knowledge. If I am successful in being awarded The Order of Australia Association Foundation Scholarship, I understand I will be required to attend the Award ceremony and to enter into a mentoring arrangement with a mentor selected by the Order of Australia Association Foundation. I agree that the decision of the National Selection Panel inselecting the scholarship awardees is final and conclusive and is not subject to any dispute.
Further, I understand giving false or misleading information is a serious offence under the Criminal Code.
Applicant signature:______Date:______

Note: Unsigned applications or those without supporting documentation will not be considered.

2014