Audit Application / Enrolment form

Audit Enrolment Form
Name*

TitleFirst NameLast Name
Preferred Name*
ACD Student Number (if previous student)
Date of Birth*

DayMonthYear
Gender*

MaleFemaleNot Stated
Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Mobile*
Home Phone
Email*
example@example.com
Home Campus*

UCLTDayspringSCMOICEDALALC
Semester*
Unit Details*

Unit NoUnit NameOn Campus / Online / Intensive
Unit Details

Unit NoUnit NameOn Campus / Online / Intensive
Unit Details

Unit NoUnit NameOn Campus / Online / Intensive
Unit Details

Unit NoUnit NameOn Campus / Online / Intensive
Method of Payment*

Credit CardFull Scholarship - ApprovedFull Scholarship - ApplyPart Scholarship - Approved (Part Payment required)MLD - Staff
Audit Fees - $350.00 per unit
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AUDDescription

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Scholarship Provider
*Please note Scholarships are only available if you are not eligible for a Fee-Help loan.

RH White Scholarships

RH White Scholarships are scholarships granted to assist students with the cost of tuition fees at Uniting College for Leadership and Theology and are made possible through the generous gifts of Richard and Emily White in 1912 and on their passing.

Richard had a passion for excellence and giving your best for God. Richard “laboured and sacrificed as few men have done to make it possible for those whom called to prepare their hearts and minds for his holy service. He was a very systematic and thorough student of the bible, and felt deeply, right to the end of life, that Scriptural truth was the only rock on which men and nations should build”.

Emily had a very strong Christian faith and active prayer life. Emily’s prayer life was well appreciated by her husband where in his tribute it was stated ”in this crisis, as often in great matters of secular business, he sought the counsel of his wife, believing that to her deep mystic experience of God some sign would be given.”
What denomination are you?*
Which congregation do you attend?*
Church involvement? e.g. Offices held*
What is your occupation / income/benefits*
Are you eligible for Austudy allowance?*

YesNo
What is the name of your employer? (if applicable)*
What is your spouse / partner's income / benefits?*
Do you have any children? What ages?*
Please give a brief account of why you are applying for this scholarship.*
Will you incur any additional expenses in order to study? E.g. Childcare, accommodation, travel. (If yes, please detail.)*
Please provide the Name, Phone and Email of two referees whom we may contact.*
Referee 1 - Minister
Referee 2 - Lay person
Privacy Statement. All the information pertaining to your scholarship application is collected and managed in accordance with the Uniting Church Privacy Policy. This information has been collected for the primary purpose of Uniting College and may be used for any activities, conducted or promoted by Uniting College. If you do not want this information to be used for any other purpose other than the assessment of your scholarship application then please notify in writing: UC Grants Committee Secretary, 34 Lipsett Terrace, Brooklyn Park SA 5032, Ph: 8416 8420. Please indicate below if you agree to these terms and conditions.*
Declaration

I certify that the information I have supplied on this form is correct and complete. I agree to abide by the ACD Constitution, Regulations and Policies, which I have read.

I accept that my personal information is collected, used and stored by the ACD in accordance with the Privacy Act 1998 and the Australian Privacy Principles prescribed by the Privacy Amendment (Enhancing Privacy Protection Act) Act 2012.

I authorise the ACD to provide my personal Information to State and Commonwealth agencies, if required to do so pursuant to state and Commonwealth Law.

I agree to the use any photos taken during college activities being used for editorial and promotional materials and the use of my email address in order for ACD to contact me relating to my satisfaction with courses or the value of courses to my subsequent activities (such as employment or lifecourse) and I understand that this information with remain confidential and any responses will be de-identified.
Type your name here*
Date*

DayMonthYear
Date
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