SCHOLARSHIP APPLICATION FOR
THE NEIL BRICE MEMORIAL FUND /

1. PERSONAL DETAILS

Last Name Given Names

Address for correspondence

Contact Number

E-mail address

Student No

2. STUDY DETAILS

Name and year (eg 3rd) of program in current year

What is your current academic load? FULL-TIME c PART-TIME c

Please attach a copy of your current academic record showing your full time enrolment

3. FINANCIAL ASSISTANCE

Are you currently receiving assistance from Centrelink? YES c NO c
Eg, Youth Allowance, Abstudy, Carer’s Allowance, Austudy.
If YES, you must attach a copy of a current Centrelink statement.
If NO, you must attach a copy of your and your parents’ (or partner’s) ATO assessment notices for the previous financial year to demonstrate your combined family taxable income. Please include any other documentation you consider relevant to demonstrate your financial circumstances.
Are you currently in receipt of any other scholarship, bursary or grant? YES c NO c
If YES, please provide the following details:
Name of Bursary/Scholarship/Grant:
Funding Body:
Year Awarded:
Value per year:
Duration of assistance:
Have you applied for any other scholarship, bursary or grant for which you are still to be notified of the result? YES c NO c
If YES, please provide the following details:
Name of Bursary/Scholarship/Grant:
Funding Body:
Year Awarded:
Value per year:
Duration of assistance:

Are you currently receiving any other financial assistance (Youth Allowance, ABSTUDY, Austudy etc)?

YES c NO c

If yes, please provide details (and attach documentary evidence):

4. BRIEF STATEMENT TO ACCOMPANY APPLICATION

Write a statement which explains your suitability for the award of this bursary (please note, the purpose of this Fund is to assist students suffering financial disability. This statement is your opportunity to demonstrate your need for assistance from the Fund.) Please attach a separate sheet if necessary.

6. DECLARATION

I declare that the information supplied by me on this form is true and correct in every particular. I authorise any person, educational institution or other body to supply information to The University of Queensland concerning this application and/or any subsequent administrative action connected with it.

SIGNATURE OF APPLICANT DATE
APPLICATION FORMS TO BE SUBMITTED TO:
APPLICATIONS CLOSE: 2 March 2018
The University takes this opportunity to advise that the value of this award may be assessable for Centrelink and/or income tax purposes. Applicants are advised to contact Centrelink and/or the Australian Taxation Office as appropriate should they require further information.

CHECKLIST OF ATTACHMENTS

c Copy of Academic Transcript of results up to and including current semester;

c Evidence of full-time enrolment in current year;

c Most recent Centrelink Allowance Statement (Youth Allowance, ABSTUDY etc);

c Australian Taxation Office Assessment Notice, for previous financial year;

c Any other evidence as outlined in the scholarship rules.