WILLIAM FLETCHER FOUNDATION

APPLICATION for a Tertiary Grant

CLOSING DATE:30APRIL 2018

There are two alternative modes of response: A or B. (See also options for Section 10)

Mode A: Using Microsoft Word software, replace blanks with required details, sign with red letters and save as:“WFF your surname & initials” (eg “WFF SmithJM”), then email with other documents to:

Mode B: Print this form (both pages), fill in the spaces provided and sign; then scan and save as
“SCAN your surname & initials”(eg “SCAN SmithJM”) and email this scan with your other documents

Your PowerPoint document should be named:
“PPT [your surname & initials]” (eg, “PPT Smith JM”).

1. surname:

2. given names:

3. date of birth:

Please advise the William Fletcher Foundation before 14 May 2018of any change to contact details:

5. addresses:

Give postal and street address (both during term and first semester vacation).

postal (term): postcode:

street (term): postcode:

postal (vacation): postcode:

6. telephone (mobile): (home) (02)

7. email address:

(your institutional email address is preferred but this must be accessible to you at all times, including vacations)

8. current institution, courseand year [eg NASBFA 3]:

9. nominated discipline (eg painting):

10. degrees/diplomas previously completed (if any):

11. Need:

These questions, concerning circumstances that may affect your studies, will assist the Foundation to assess your need for a Grant.
NB: All information will be treated in strict confidence

Mode A: Show your response in a Word document by changing from blue to red.
Mode B. Circle the appropriate response in each of a. to k.

a. Which of these, if any, do you have this year?
HECS loan • family allowance • scholarship • other grant • none of these

b. Do you provide support for other family members?
YES • NO

c. What is your living accommodation?
living with parents • rented • boarding • owned (with mortgage) • owned (outright)

d. What total distance (in km) do you travel to and from campus each day during term (approximately)?
less than 6 • 6–10 • 11–15 • 16–30 • more than 30

e. How many hours each day do you spend in travel to and from campus (approximately)?
less than 0.5 • 0.5–1 • 1–2 • 2–4 • more than 4

f. Are you able to use public transport to and from campus?
YES • NO

g. How do you travel to and from campus?
public transport • drive own car • driven • motor cycle • bicycle • walk

h. Does your study timetable allow you to do part-time work?
YES • NO

i. Are part-time employment opportunities available to you?
YES • NO

j. Are you currently employed?
YES • NO

k. How many hours per week do you work?
0 • 0–5 • 5–10 • 10–15 • more than 15

l. Additional comment to support your case for need (optional):

12. Declaration:

I hereby apply for a William Fletcher Foundation Grant to assist me to complete my art studies; and
I hereby declare that:

•I am an Australian citizen; and

•all information provided by me is accurate; and

•I have provided a certified Transcript of my Academic Record, having shown it to my Contact; and

•the two artworks on the accompanying PowerPoint were executed by me; and

•I have informed my institution’s Contact person that I am applying in my nominated discipline

Signed or name in red: dated:

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