Caroline Chisholm Education Foundation - DOC

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					                                                                                                                        Caroline Chisholm: Picture courtesy National Library of Australia
                                Caroline Chisholm
                              Education Foundation
CONFIDENTIAL                                                        “I promise to know neither country nor creed,
                                                                             but to serve all justly and impartially”


  Engineering/Manufacturing Scholarship Application
                             Please
                             circle
                                             Mr          Mrs              Ms                Other


          Name
                            Surname _________________________________________________

                            Given ____________________________________________________




                            _________________________________________________________
        Address
                            _________________________________________________________

                            _________________________________Post Code________________


       Telephone
                  Home _________________________________________________________

                  Mobile _________________________________________________________
                            _________________________________________________________
                   Email

           Age                             Date of Birth                                   1 9
                            Australian Citizen               Arrival in Australia           Country of Birth
    Resident status         Permanent Resident
        (Please tick)
                            Humanitarian Visa
   Healthcare Card          Yes       No                            Fee Concession                  Yes        No

   Student Number

     Course Name
   Length of Course            1 Year             2 Years             3 Years                     4 Years
       (Please circle)
      Current Year            1ST Year            2nd Year            3rd Year                    4th Year
       (Please circle)
                                           Tuition                                    Are you eligible for
           Fees                                                                       VETFeeHelp?
                                      Amenities
        NOTE: An                                                                      YES                     NO
   indication of tuition,               Materials
      amenities and
   materials fees must
       be included
                              Total Fees
                                       Selection Criteria
                If necessary, please attach any relevant documentation or additional information
1. Demonstrated         Attached: (Please tick)
   hardship
                       Institute records

                       Concession Card

                       Other agencies


2. Academic             Attached: (Please tick)
   record
                       Secondary school record

                       Copy of results

                       Other (Please specify/attach)

3. Commitment           Applicant should indicate their positive approach to studies through
   to study             attendance, attitude, participation and approach to tasks




     NOTE:              Applicant should indicate difficulties in pursuing studies in the face of
It is strongly          adverse experiences and challenges
advised that
applicants indicate
clearly in this
section any
disadvantages to
further study,
which may include
current or lifetime
experiences or
financial barriers




4   Personal and        Applicant should indicate personal qualities which may include:
    other key
    attributes              interaction with and respect for peers and teachers




                            effective interpersonal skills
                            active involvement in clubs or community organisations such as
                             sporting clubs, Amnesty, Red Cross, local schools




5    Personal          Applicant should indicate their determination to continue with their studies
     growth            which may include:

                            striving to reach their personal potential




                            displaying qualities of self-motivation and self-direction




                            indicating how learning will play a positive role on personal growth




    Recommended       Name               _______________________________________________
         by
                      Signed             _______________________________________________


                      Department         ________________________ Extension ______________




     Applicant’s      Signed             _______________________________________________
    endorsement
                      Date               _______________________________________________


Guidelines on eligibility are available on the Foundation website at www.CarolineChisholm.org.au

NOTE:       It is strongly recommended that applicants indicate clearly on the
            Application Form any disadvantages to further study, which may include
            current or lifetime experiences.

Please return the completed Application Form to:

Executive Officer                                     or by Chisholm Institute internal mail to:
Caroline Chisholm Education Foundation
PO Box 684                                            Jo Saunders
Dandenong Vic 3175                                    Building Z
                                                      Frankston campus

				
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posted:9/16/2012
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