angliss higher ed

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William Angliss Institute Higher Education Scholarship Application Form(please attach to your degree application form)

Section A: Personal Details William Angliss Institute Student ID No. (current students only):

Title: Mr Mrs Ms Miss

Surname or Family name:

Given name(s):

Date of Birth: D D / M M / Y Y Y Y Sex: Male Female

Home address

Address:

Suburb: State: Postcode:

Telephone: ( ) Mobile: ( )

Email

I am enrolling into:

Bachelor of Tourism and Hospitality Management

Bachelor of Culinary Management

I would like to apply for:

An Academic Excellence Scholarship

An Equity Scholarship

Note: You can apply for both types of Scholarships. If you would like to do this, select both boxes and complete sections B and C.

Previous Tertiary Education

In which state or territory of Australia did you complete year 12?

Your ENTER score achieved in Year 12: Year that you completed year 12:

School name: Suburb: Postcode:

Please tick below

Do you have a disability that impacts on your study? Yes No

Have you grown up in, or ever lived in a rural and/or isolated region Yes No

If you answered YES, Place: Postcode:

Have you been the recipient of a Commonwealth Learning Scholarship (CLS) previously? Yes No

i. If yes, at which Institution did you receive CLS?

ii. Years received payment?

iii. Which scholarship(s) did you receive?

Commonwealth Education Costs Scholarship

Commonwealth Accommodation Scholarship

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William Angliss Institute Higher Education Scholarship Application

Section B: Applications for Academic Excellence ScholarshipsPlease list any academic awards you have obtained through secondary school

Please attach all Secondary School results and Academic Transcripts (if applicable).

Section C: Applications for Equity ScholarshipsThere are two categories of Equity Scholarships. You can apply for one or both.

If applying for both, please complete sections D and E.

a. Equity for Financially Disadvantaged Applicants (complete questions 1-8 and Section D)

b. Equity of Educationally Disadvantaged Applicants (complete questions 1-8 and Section E)

Q1. Did you move away from home to complete the majority of your secondary schooling? Yes No

Q2. Did you receive any financial assistance including scholarship funding to allow you to attend? Yes No

Q3. Have you needed to move away from home in order to attend William Angliss Institute? Yes No

Q4. Are you currently in receipt of any government income support such as Youth Allowance, Austudy or Abstudy? Yes No

If you answered YES, please provide:

Type of benefit: Amount received per fortnight: $

If you are in receipt of any government income support such as Youth Allowance, Austudy or Abstudy, you will need to attach a photocopy of your documentation.

Q5. Do you or your family (if you are aged under 25) hold a current Health Care card? Yes No

*If you answered YES, you will need to attach a photocopy of your Health Care card.

Q6. Financial details:

Estimated gross total annual government benefit payments $

Estimated gross annual income excluding government assistance (eg, from work) $

Total gross annual income $ A

You are required to attach a photocopy of your most recent tax return, Centrelink statement of income, or pay slips for the last 12 weeks of work.

Please note: if you live alone/away from home, but your parents still assist with your living arrangements and or other expenses, you also need to attach their financial details. However, if you have no income, we need an explanation as to how you afford your living arrangements and other expenses. This explanation can be provided here:

Q7. With whom do you normally live? (tick all that apply of the following and complete as appropriate)

Employment type of parent/ guardian Eg. Full/Part-time, Unemployed

Occupation of parent/ guardian

Estimated Gross Total Government Benefits

Estimated Gross Annual Income (Exc. Government Assistance)

Mother or Stepmother $ $

Father or Stepfather $ $

Partner / Spouse $ $

Other $ $

B Total $ C Total $

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You are required to attach for each member of the household (as answered above) a photocopy of each members most recent tax return, Centrelink statement of income, or pay slips for the last 12 weeks of work.

Q8. Please fill in the following as answered in questions 6 and 7 above:

Total Household Financial DetailsYour total gross income as stated in Question 6. $ A Total

Your households total gross government benefits received (excluding yourself) as stated in Question 7. $ B Total

Your households total gross annual income excluding government assistance as stated in Question 7. $ C Total

Total Annual Income $

Section D: Financially Disadvantaged Equity Students OnlyPlease describe in some detail any financial disadvantage which you may have experiencedindicating whether this was during secondary or tertiary schooling. This may include, for example, the financial strains of living in an isolated region in a drought-affected environment, or any other disadvantage that may have affected your financial situation. Please attach extra sheets if there is insufficient space.

Section E: Educationally Disadvantaged Equity Students OnlyPlease describe in some detail any educational disadvantage you have experienced and indicated the affected level of schooling. This may include lack of resources, living in an isolated region, no computer or internet access, carer responsibilities, or any other disadvantage that may have affected your education. Please attach extra sheets if there is insufficient space.

Section F: Further InformationPlease provide any information about any community involvement, personal interests, or career ambitions that you feel are relevant to your application. Please attached extra shees if there is insufficient space.

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Note to the ApplicantThe Student Equity Unit, Student Services, will contact you should further information be required.

A final decision on your application will not be made until after the closing date.

All applicants will be notified in writing of the outcome of their application.

No information regarding the progress of applications can be given to applicants during the selection process.

Please consult a financial advisor to be advised of any tax implication, including government benefit payments, which may affect you if an award is made to you. If you are in receipt of a government benefit you are required to notify Centrelink of any award you may receive.

This scholarship is for local students only.

Checklist Ensure you have completed all relevant sections of the application form

Please ensure you have attached all relevant documentation as requested. Anywhere you see a documentation needs to be provided

Do not attach any original documents

Sign and date the application form in Section G.

Submitting the ApplicationTo be eligible, applications must be submitted no later than 10 March 2014.

Applications should be delivered o r posted to:

Higher Education Administration Coordinator Information Centre William Angliss Institute PO Box 4052 Melbourne VIC 3000

Section G: Applicants DeclarationThe information provided by you in this form is for the purpose of assessing your eligibility for a scholarship. William Angliss Institute collects, uses and destroys information in accordance with our Privacy Policy. The privacy statement can be viewed at www.angliss.edu.au. Enquiries relating to information included on this form should be directed to the Scholarship Officer on tel. (03) 9606 2111.

I give permission to the Scholarship Officer to access my William Angliss Institute enrolment details and my academic results (for continuing students) to assess my eligibility for this scholarship.

I declare that to the best of my knowledge the information provided is correct and complete. Giving false or misleading information is a serious offence under the Commonwealth Criminal Code.

Signature of Applicant: Date: D D / M M / Y Y Y Y

Office use onlyScholarship application: Merit Equity

Scholarship application successful:

Scholarship application unsuccessful:

Approved by: (Name)

Signature: Date: D D / M M / Y Y Y Y

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