The Woss Family Jazz and Music Theatre Scholarships

Application Form

All sections on the application form must be completed and supporting documentation must be provided where 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. /
Date of Birth: / Click here to enter text. / Gender: / Male ☐ Female ☐
Current Address: / Click here to enter text. /
Suburb Click here to enter text. Postcode Click here to enter text.
Permanent Home Address: (If different from above) / Click here to enter text. /
Suburb Click here to enter text. Postcode Click here to enter text.
Home Phone: Click here to enter text. / Mobile: Click here to enter text.
Please ensure that your correspondence address details are updated on SIMO
  1. Are you an Australian Citizen ☐ or A Permanent Resident ☐

  1. Are you studying full time in on campus units?
/ ☐Yes ☐ No
  1. What year of which course are you enrolled in?
2nd Year ☐ 3rd year ☐
Bachelor of Music (Jazz) course ☐ Bachelor of Arts (Music Theatre) ☐
Financial and personal Circumstances
  1. Are you of Australian Aboriginal or Torres Strait Islander descent?
/ ☐Yes ☐No
  1. Do you have a disability or ongoing illness that significantly affects your ability to study?
/ ☐Yes ☐No
  1. If you have a disability or ongoing illness, are you registered with the ECU Equity Diversity and Disability Office?
/ ☐Yes ☐No
  1. Do you provide care for any person with special needs or ongoing illness?
/ ☐Yes ☐No
  1. Are you personally in receipt of a means tested allowance from Centrelink or the Department of Veterans Affairs?
8b.If yes, please identify the allowance below
Click here to enter text.
And
8c. complete the Centrelink Consent form and attach to your application / ☐ Yes –
Complete Q8B & Q8C
☐ No – go to Q9
  1. If you are not in receipt of a Centrelink allowance please outline any reasons why you may be financially disadvantaged
    2. Click here to enter text.

  1. Are you in receipt of a valid current Health Care Card?
/ ☐Yes
☐ No
  1. What other personal or family income (if you are dependent on your family’s income) do you receive per fortnight?
Gross Average Fortnightly Income / Amount $
Salary/Wages (gross) / $Click here to enter text.
Assistance from family / $Click here to enter text.
Child Support / $Click here to enter text.
Other (e.g. shares, investments, bank interest, etc.) / $Click here to enter text.
Total / $Click here to enter text.
  1. What are your gross average fortnightly expenses?
Fortnightly Expenses / Amount $
Rent/Board/Mortgage / $Click here to enter text.
Food/Groceries / $Click here to enter text.
Phone, Power, Utilities / $Click here to enter text.
Transport (Transperth, car costs including insurance, registration, etc.) / $Click here to enter text.
Childcare / $Click here to enter text.
Loan Repayments / $Click here to enter text.
Incidentals/Other / $Click here to enter text.
Total / $Click here to enter text.
  1. Please identify your living situation

Single (living with parents/guardians/family members)
Single (living away from home/financially supported by parent/guardian)
Single(living away from home/financially independent)
Single with dependants
Partnered with no dependants
Partnered with dependants
Other (please describe)
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  1. Personal Statement
Please attach a personal statement (Max 2 x A4 sides) describing
  • Your circumstances either past or present, which have had an impact on your life and capacity to give time and attention to your studies
  • How you would personally benefit from the scholarship, if you were to receive it?

  1. References/referees
  • Please attach two written references with the names and contact details of the referees

  1. Brief resume
  • Please attach a brief version of your resume (maximum of 2 sides A4 page)

  1. Checklist – Please tick to indicate that you have attached the following supporting documentation to this application form. Failure to provide supporting documentation may affect you receiving a scholarship offer.

☐ / Evidence of Australian Citizenship
☐ / Completed Centrelink Customer Consent form
☐ / If applicable, evidence of your interstate address (i.e. drivers licence, high school report, official bill with your interstate address on it)
☐ / A personal statement as outlined above (Question)
☐ / Two written references
☐ / Brief resume
  1. Student Declaration
I declare that the information I have supplied within this application is true and correct to the best of my knowledge. I understand if any false or misleading information is provided it could lead to the cancellation of my scholarship. I also understand giving false or misleading information is a serious offence under the Criminal Code.
I consent to the disclosure of relevant information for the selection process of this scholarship

Signature of Applicant: Click here to enter text.

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Date: Click here to enter a date.