Koori Mail Scholarship

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                   Mr/Ms       Given names you are enrolled under               Family name you are enrolled under




                   Any other name you use                        Your date of birth             Your place of birth




                   Your usual residential address
PERSONAL DETAILS




                   Your usual postal address                                                            Postcode




                   Your postal address while attending Batchelor Institute (if different from above)




                   Home Community                                           Email address




                   Home phone no.           Work phone no.              Mobile Phone No,               Fax No.
                       Name of the Batchelor Institute course you are enrolled in                                                                                          Your Student Number



                       When did you start this course?                                                                                 Full-time or part-time student in 2005?
ACADEMIC HISTORY




                       Fill in this table for any other tertiary education courses you have started and include a copy of
                       the relevant academic records with your application.
                                         NAME OF COURSE                                               NAME OF INSTITUTION                                        WHEN STUDIED            COMPLETED?




                       Fill in this table for any awards, bursaries, scholarships or other financial assistance you have
                       received in the past or are receiving now
                                               AWARD/ASSISTANCE                                                                          RECEIVED FROM                                      YEAR/S




                       Your current or most recent occupation or employment (if any)
 OTHER INFORMATION




                       Fill in this table for any other media-related activities you are involved in and forward any
                       relevant documentation with your application.
                                                    ACTIVITY                                                               WHERE                                           TYPE OF INVOLVEMENT




                       What are your hobbies or interests?



                       If you are awarded this scholarship how will you use it?



     As part of your Koori Mail Scholarship application, please attach a statement which describes your
     goals upon completing your studies at Batchelor Institute, and your long term goals in the media
     industry. The statement must be no longer than one page and signed by you as your own work.

                       The information I have submitted is correct and complete. ...................................................yes                                                        no
 D E C LA R A T I ON




                       I have attached my signed statement about my goals as part of my application. ..yes                                                                                     no

                       I have attached other documents to this application ...............................................................yes                                                  no


                       Signature: ......................................................................................................................................      Date: …../…../2006

     POST OR FAX YOUR COMPLETED APPLICATION & ANY ATTACHMENTS                                                                                                        Do you have a query?
     TO:
                                                                                                                                                                    Fax your query or ring the Staff &
     Academic and Research Division                                                                                                                                 Student Services Division.
     Batchelor Institute                                                                                                                                            Attention: Institute Scholarships
                                                                                                                                                                    Officer
     PO BATCHELOR NT O845                                                                                  Fax (08) 8939 7331
                                                                                                                                                                    Free-call 1800 677 095

                              APPLICATIONS MUST BE RECEIVED AT BATCHELOR INSTITUTE
                                                 BY 31 March 2007
APPLICATIONS MUST BE RECEIVED AT BATCHELOR INSTITUTE
                   BY 31 March 2007

				
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Description: Koori Mail Scholarship