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Application Form for Undergraduate Students by OGp49t8

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									  Wyndham Richardson Tertiary Student Care Trust Scholarships

The Wyndham Richardson Tertiary Students Care Trust was first incorporated in July 1983 as
the St Peter’s Collegians Tertiary Students Care Trust. It was renamed in October 1999 to
perpetuate the name of its benefactor, Wyndham Richardson. The Trust has helped students
by providing accommodation assistance, loans and grants for individual students, and with
the establishment of the Wyndham Richardson Careers Centre at St Peter’s College.
Four scholarships valued at $1750 each are available for commencing and continuing
students who are Australian citizens or permanent residents of Australia and undertaking a
program of study on a full time basis in a Commonwealth supported place at the University of
Adelaide.
To be eligible, students will need to demonstrate that they are financially disadvantaged and:
          (i) they normally reside outside metropolitan Adelaide or outside any other major
               Australian city; or,
          (ii) they normally reside in the Adelaide metropolitan area however, will be studying
               and residing at locations remote from their normal place of abode; (e.g. studying
               and residing at Roseworthy College) and
          (iii) they are residing in a residential college affiliated with the University of Adelaide
                or in rental accommodation. (Proof will be required).
In certain circumstances, other students who are able to demonstrate that they are
disadvantaged and worthy of special consideration may be considered for this scholarship
with the approval of the Chairman of the Trust, including applicants living at home.
Applicants need to demonstrate financial need and be able to provide supporting
documentary evidence at the time of applying e.g. details of income tested Commonwealth
income support payment such as Youth Allowance, Austudy, ABSTUDY benefits, or other
details of their financial circumstances.
Selection for this scholarship will be made according to academic merit and financial need.
Academic merit will be determined according to TER scores or academic records. The
Scholarship must be taken up in the year in which it is offered.
Students in receipt of the Commonwealth Accommodation Scholarship (CAS) or Relocation
Scholarship are not eligible for this Scholarship.
Once applications open the application form is downloadable from the University’s website at
http://www.adelaide.edu.au/scholarships/undergrad/ or available from the Student Centre.
Applications close: Friday 4 March 2011
Wyndham Richardson Tertiary Student Care Trust
Scholarships 2011
APPLICATION FORM
Four scholarships valued at $1,750 each are available to assist with accommodation expenses for students who meet the eligibility
conditions as outlined in the attached information sheet.

Scholarship applications close Friday 4 March 2011.

Personal Details

Title:              Family Name:                                             Given Names:

Permanent Home Address:

                                                                       State:                       Post Code:

Home Phone Number:

Semester Postal Address:

                                                                       State:                       Post Code:

Semester Phone Number:                                                 Mobile Number:

Email Address:


What is your date of birth? ……………./…………/………..                             Gender :        M                 F


PLEASE SUPPLY YOUR UNIVERSITY OF ADELAIDE STUDENT NUMBER:
Are you:          An Australian citizen
                  An Australian Permanent Resident
                  Other

Are you of Aboriginal or Torres Strait Islander origin?              Yes                       No
                                                                    (You may be required to provide confirmation of Aboriginality e.g.
                                                                    evidence of ABSTUDY or endorsement by an Aboriginal or Torres
                                                                    Strait Islander Organisation.)

Do you have a disability?                                           Yes                       No




                                                                                                                                2
Academic Background Details

What year were you last enrolled in secondary school?             …………………………………………………………..……


Which school/college did you attend?
                                                                  …………………………………………………………..……
                                                                  Name of school
                                                                  ……………………………………………………………….
                                                                  Address of school                         State         Postcode
Were you in receipt of a scholarship to attend this               Yes               No
school/college?
                                                                  If yes, please name scholarship:
                                                                  …………………………………………………………..……
Have you applied for University entrance through a Special        Yes               No
Entry Scheme.
Have you undertaken other post-secondary study?                   Yes                No
                                                                  If yes, please provide details of study undertaken and of the highest
                                                                  qualification you achieved (e.g. Certificate IV in Business from TAFE)

                                                                  …………………………………………………………..……


Have you already undertaken any tertiary study at an              Yes              No
Australian University, or with a higher education provider?
                                                                  If yes, please provide details of your earlier study:

                                                                  …………………………………………………………..……
                                                                  …………………………………………………………..……


Have any members of your family completed Tertiary                Yes              No
Education?
                                                                  If yes, please provide relationship and level of qualification:

                                                                  …………………………………………………………..……
                                                                  …………………………………………………………..……

Please include copies of the following (where appropriate) with this application:
        Copy of your Year 12 result, where this was not completed in South Australia (e.g. VCE certificate);
        Copy of your academic records from any university you have attended
        Copy of academic records from overseas institutions, which should be accompanied by official translations and any
         documentation relating to the recognition of this qualification in Australia
        Evidence of other academic qualifications (e.g. TAFE diploma)




                                                                                                                                     3
University Study Details

Which undergraduate program of study will you be                 …………………………………………………………..……
undertaking in 2011? (e.g. Bachelor of Arts)
Which campus will you be based at?                               …………………………………………………………..……


Which year of study will you be undertaking in 2011? (e.g.       …………………………………………………………..……
Year 1)

Will you be undertaking study at the University of Adelaide      Yes              No
as an internal student on a full time basis*?
* Full time study means that you are undertaking at least 75%
of the maximum full time student course load (at least 9 units
per semester).

Are you undertaking study as a Commonwealth Supported            Yes              No
student?

How did you find out about this scholarship?
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………



Have you applied for any other University scholarships?       Yes                 No
        If yes, please provide details of scholarships applied for:
                                   ……………………………………………………………
         ……………………………………………………………………………………………………….………………………
Do you hold any other scholarships currently?                    Yes              No
        If yes, please provide details:
         Name of Scholarship:
         Organisation providing Scholarship:
         Annual payment:
         Date scholarship commenced:                /    /         Date scholarship will end:   /   /




                                                                                                        4
`
Financial Situation

1) Are you currently in receipt of a means
tested Commonwealth income support           Yes                   No     – please go to question 2
payment? (e.g. Austudy, ABSTUDY, Youth
Allowance, etc)                              If yes, please provide the following details
                                             Type of payment:
                                             Payment commencement date:                     /         /
                                             Documentary evidence MUST be supplied (e.g. current Centrelink statements
                                             showing entitlements and rate of pay)

2) Do you expect to receive a means          Yes                   No     – please go to question 3
tested benefit in the near future?
                                             Please attach a supporting letter from Centrelink or similar documentation

                                             Anticipated payment commencement date:                   /   /


3) If you are NOT in receipt of a means
tested income support payment, please
provide details of your sources of income:   Sources of income:
(e.g. family support, salaries, other        a) Income source                           Amount per week: $
scholarships etc).                           (e.g. Parental/spouse income)

                                             b) Income source                           Amount per week: $
                                             (e.g. Own earnings)

                                             c) Income source                           Amount per week: $
                                             (e.g. Child support payments)

                                             Supporting documentary evidence MUST be supplied (e.g. this should include
                                             copies of your and/or your parents or spouse’s current ATO assessments, or other
                                             independent documentary evidence of income).
4) Please provide a statement outlining
the circumstances that you consider
demonstrate that you are in financial
need.




                                                                                                                            5
Personal Statement
Please provide a short statement (less than 200 words) to support your application for a Wyndham Richardson Tertiary Student
Care Trust Scholarship, in particular addressing how this funding would assist you in meeting your accommodation costs.




Declaration

I declare that the information I have supplied on this form is true and correct to the best of my knowledge. I understand that the
scholarship may be cancelled if it is proven that I was offered a scholarship based on false or misleading information or
documentation.

I authorise the University of Adelaide to obtain such additional information deemed necessary to assess my application for this
scholarship.

I understand that the University will not disclose any information supplied on the application form or obtained for the selection
process without written consent of the applicant. The information supplied will only be used for the selection process of this
scholarship program and will be managed in accordance with the University of Adelaide Privacy Policy and Management Plan
available at http://www.adelaide.edu.au/policies/62

I agree to the University providing a report on my progress to Wyndham Richardson Tertiary Student Care Trust at the end of
the year should I be awarded the scholarship.


Applicant signature:                                                    Date:



If you have any questions about your application, please contact the Scholarships Office on (08) 8303 4224 or (08) 8303 3341, or
email: undergraduatescholarships@adelaide.edu.au
Please forward the completed application form to:
Scholarships Office C/- The Student Centre, The University of Adelaide, SA 5005 Australia         Closing date: 4 March 2011




                                                                                                                                   6
Wyndham Richardson Tertiary Student Care Trust
Scholarships 2011

These scholarships are available to assist students who are commencing or continuing students undertaking full time study at the
University of Adelaide. To be eligible for consideration, students will need to demonstrate that they are financially disadvantaged
and that they: (i) normally reside outside metropolitan Adelaide or outside any other major Australian city; or,
                (ii) normally reside in the Adelaide metropolitan area however, will be studying and residing at locations remote from
                      their normal place of abode; (e.g. studying and residing at Roseworthy College) and
                (iii) are residing in a residential college affiliated with the University of Adelaide or in rental accommodation.
In certain circumstances, other students who are able to demonstrate that they are disadvantaged and worthy of special
consideration may be considered, including applicants living at home.

Further information is available at the University’s website at: http://www.adelaide.edu.au/scholarships/undergrad/

REFEREE REPORT


The following person is applying for the above name scholarship at the University of Adelaide in 2011. Please provide a confidential
report confirming the applicant’s suitability for the award to assist in the final scholarship selection. Thank you for your assistance.


Applicant’s Name:




Referee’s name (Please print):
Position held and Organisation:
Address:
Phone:
Relationship to applicant:
Referee’s signature:                                                                        Date:


Please forward the completed referee report to along with the completed application form to:
Scholarships Office C/- The Student Centre, The University of Adelaide, SA 5005 Australia               Closing date: 4 March 2011
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