Application for Needs-Based Bursary

2. Financial Information
1. Do you currently receive an Australian Government/Centrelink Allowance or Austudy?*

YesNo
2. If so, what type of Centrelink Allowance/Austudy do you receive?

Living Away from Home AllowanceRelocation ScholarshipIndependent for Youth AllowanceFull Youth Allowance/AustudyPart Youth Allowance/AustudyOther
3. How much do you receive per fortnight?
Please attach a letter from Centrelink that confirms your receipt of any benefit/s and the amount/s paid to you or a printout from

Centrelink of your recent payments to this application. (Please see "4. Attachments" section below).

3. Parental Income
1. What is the combined taxable income of both parents for the last financial year?
If you do not live with both parents include only the income of your supporting parent, adding any maintenance payments from the non-supporting parent. If you are unable to supply this information please attach a statement to explain your circumstances.
2. Number of siblings 15 years and under.
3. Number of siblings 16 to 23 years who are studying full time.

4. Personal Circumstances
In a brief statement, please outline your reasons for seeking a Needs-based Bursary.*

0/250
What steps have you or people who are important in your life been able to take to assist with these issues?*

0/250
How have these circumstances affected you in the past?*

0/250
How do these circumstances affect you now?*

0/250
How do you feel that these circumstances may affect your progress at University?*

0/250
What personal strengths do you possess that will help you to succeed at University?*

0/250

5. Declaration
1. I declare that the information supplied by me on this form is true and accurate in every particular.2. I understand that all information that I have included in this application will be treated as strictly confidential.3. I understand that any scholarship awarded is not transferable to cash.4. I understand that all scholarship funds are repayable on early termination of the Halls of Residence Agreement.5. I have read and understand the Scholarship/Bursaries Terms and Conditions, as provided on the Halls of Residence website.
Name of Applicant*

First NameLast Name
Signature of Applicant*
Date*

DayMonthYear
Date
To submit the application please click the submit button no later than 13 February
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