APPLICATION FOR A SHORT LEAVE OF ABSENCE

							  Bachelor of Biomedicine
  Faculty of Medicine, Dentistry & Health Sciences
  MDHS Student Centre




        APPLICATION FOR BIOMEDICINE SCHOLARSHIP 2010


VTAC Application Number:

Applicant Name:

Address:



Contact Telephone Number:

Contact Email address:




Applicant’s signature:                                    __________

Date:




        ALL APPLICATIONS MUST BE SUBMITTED BY 10 DECEMBER 2010.




                    Please return form and personal statement to:


                                     MDHS Student Centre
                                 Ground Floor, Medical Building
                                  The University of Melbourne
                                       Victoria,    3010
                         Marked attention 'Biomedicine Scholarships'