THE R D ARIDA BURSARY 2017
APPLICATION FORM
1.Family Name......
Given Names......
2.Student Number......
3.Email Address......
4.Home Address ......
5.Mobile......
6. Date of Birth...... 7. Place of Birth ......
8. Is your home residence in North Queensland? YES NO
If yes, please attach evidence
9.Is your home residence in one of the districts of Charters Towers, Hughenden or
Cloncurry? YES NO
10.Period of Residence: ......
11.What program have you been accepted into for the current academic year?
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12.Have you previously undertaken any tertiary level study(for example Enhanced Studies at UQ)? YES NO
If yes, please provide the details:
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Demonstrating academic achievement in secondary school
All applicants must attach a copy of their Tertiary Entrance Statement showing OP.
Demonstrating Financial Need
You must demonstrate financial need in one of the following ways:
(i)If you receive a Centrelink Allowance, submit a copy of your most recent statement
(ii)If you do not receive a Centrelink Allowance, you must submit one of the following:
(a)a copy of your and your parents' ATO Assessment Notice for the previous year; or
(b)if your financial circumstances have dramatically changed since your previous tax return please provide additional evidence.
13. Are you currently in receipt of any other scholarship, bursary or grant? YES NO
If YES, please provide the following details:
Name of Bursary ......
Funding Body ......
Year Awarded ......
Value per year ......
Duration of assistance ......
14. Have you applied for any other scholarship, bursary or grant for which you are still to be notified of the result? YES NO
If YES, please provide the following details:
Name of Award ......
Year Awarded ......
Value per year ......
Duration of assistance ......
Statement to accompany application
This is your opportunity to provide any other information you think the selection committee should be aware of, in support of you application. For example, you may wish to outline financial circumstances which make it difficult for you to attend University.
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SIGNATURE OF APPLICANT...... DATE ......APPLICATION FORMS TO BE MAILED TO:ADMINISTRATIVE OFFICER
UNDERGRADUATE SCHOLARSHIPS & PRIZES
JD STORY BUILDING
THE UNIVERSITY OF QUEENSLAND QLD 4072
OR DELIVERED TO:ANY UQ STUDENT CENTRE, ADDRESSED AS ABOVE.
CLOSING DATE: SUNDAY, 5 MARCH 2017