2018APPLICATION FORM

The Australian Psychological Society bursaryof Financial Assistance for People of Aboriginal and Torres Strait Islander Descent:

The Bendi Lango bursary

The closing date for applications is Friday 30 March 2018.

Please attach:

A letter confirming your Aboriginal and/or Torres Strait Islander heritage

Documents demonstrating your financial position

Copy of academic transcript and proof of acceptance/enrolment into postgraduate degree

Completed Community Referee Report

Completed Academic Referee Report

To:

  • Email:
  • Post: The Administrator, Science and Education

The Australian Psychological Society Ltd

PO Box 38

Flinders Lane VIC 8009

Enquiries:

  • Email:
  • Phone: (03) 8662 3300

  1. Information about the applicant

Title: / ...... / First Name: / ...... / Family Name: / ......
Address: / ......
......
......
......
Telephone: / ...... / Mobile: / ......
Email: / ......
APS membership grade
(if applicable): / ...... / Membership number: / ......
  1. Confirmation of Aboriginality

Please attach a letter of Aboriginal and/or Torres Strait Islander heritage by an Indigenous organisation who has a common seal of certification.(Other proof of heritage may be considered at the discretion of the Selection Committee)

Name of organisation: / ......
Address: / ......
......
......
......
Telephone: / ......
Email: / ......
  1. Personal statement

Please note that your personal statement plays an important role in selecting the recipient(s).

Please complete the three sections below:

Q1: Please comment on the contribution you have made to your community and the broader community to date (max. 300 words)
Q2: What are your planned future contributions to your community and the broader community? (max. 300 words)
Q3: What would the receipt of financial assistance from the APS mean to you? (approx. 100-150 words)
  1. Financial statement

In acknowledgement of the hardship faced by many people of Australian Aboriginal and Torres Strait Islander descent, the APS has established the Bendi Lango bursary for the purpose of offering funding to alleviate some of these financial concerns. Donations to the APS fund set up for this bursary are tax deductible. Therefore, the Australian Taxation Office requires us to ask you for some evidence of your 'necessitous financial circumstances'.

Please complete the section below:

Financial statement: Please provide a written statement of your financial need.
Please include one or more of the following as evidence:
(i)A copy of your most recent tax return
(ii)The basis on which you have been assessed as qualifying for social welfare, if applicable (e.g. Healthcare card, Abstudy/Austudy, Centrelink benefit)
(iii)Any other circumstances which may be causing you financial hardship.
  1. Education details

Please attach a copy of your academic transcript(s) to date, as well as proof of offer and acceptance, or enrolment, in an APAC-accredited postgraduate psychology coursework degree

Undergraduate course details:
......
Years of study: / ......
Details of proposed/current postgraduate course:
......
  1. Communityreferee

Please complete the below table with the name and contact details of your community referee(The Selection Committee recommends that the report come from an individual or organisation familiar with your community contributions)

Name of community referee: / ......
Contact number: / ......
Email: / ......
  1. Academic referee

(For example: Academic supervisor / Director or Staff of Indigenous Centre)

Please complete the below table with the name and contact details of your academic referee

Name of academic referee: / ......
Contact number: / ......
Email: / ......

Signature of Candidate:

Print name:

Date:

The closing date for applications is Friday 30 March2018.

The completed application form with required attachments should be emailedto:.

Alternatively, all documentation can be sent to:

The Administrator, Science and Education

Australian Psychological Society

PO Box 38

FLINDERS LANE VIC 8009