Important: Do not print this document or complete in hand-writing. Click on the highlighted grey boxes and type in your response or select the relevant response provided. Save and submit the document as per instructions in Section 17.
All applications will be considered against criteria for each of the available Sport Scholarships and/or Grants for the year – hence, applicants do not need to apply for a specific scholarship or grant. This application will also be used to determine a student-athlete’s eligibility to be considered under the University’s Elite Athlete and Performers policy.
1. Scholarship Application TypeSelect TypeNew Melb Uni Sport Scholarship ApplicationPrevious Melb Uni Sport Scholarship RecipientCoaching Development Grant Application
If you were a previous Sport Scholarship recipient, in what year? Select Year20102009200820072006
2. Personal Details
First Name: / Surname:
Date of Birth (dd-mm-yyyy): / Gender: SelectFemaleMale
Postal Address:
Suburb: / State:SelectVICACTNSWNTQLDSATASWA / Postcode:
Preferred Email:
Home Telephone: / Mobile Telephone:
3. Academic Details: Only currently enrolled students are eligible to applyfor scholarships (except for Coaching Development Grants which are open to University club coaches)
Student Number: / I am not a Melbourne Uni student
Faculty:Please SelectArchitecture, Building & PlanningArtsBusinessEconomics & CommerceEducationEngineeringLand & Food ResourceLawMedicine, Dentistry & Health SciencesMusicScienceVeterinary ScienceVictorian College of the Arts / Course:
Year of Study:Please Select1st Year2nd Year3rd Year4th YearHonoursMastersPhD / Expected Year of Completion Please Select2011201220132014Beyond 2014
4. Sporting Details
Nominated Sport:
Position/Discipline/Event:
5. Club Affiliation:Which club do you currently compete for/coach?
Club:
If not currently competing for MelbourneUniversity, are you prepared to transfer clubs?
6. Personal Best Times/Distances/Scores over the past 24 monthsEvent/Discipline
eg. 100m / PB
eg. 10.37 secs / Competition
eg. Victorian Championships / Date Achieved
(dd-mm-yyyy)
7. State/National Rankings over the past 24 months / Date Achieved
(dd-mm-yyyy)
State Ranking eg. 1st U/23 Single Scull:
National Ranking eg. 2nd Open 400m
8. Representative Honours over the past 24 months / Date Achieved
(dd-mm-yyyy)
Regional Level eg. Western Zone Schools
State Level eg. Vic U/21 team:
National Level eg. Australian Olympic team
9. Other significant Sporting/Coaching Achievements over the past 24 months / Date Achieved
(dd-mm-yyyy)
1.
2.
3.
10. Have you been awarded a Scholarship at an Institute or Academy of Sport in the past 24 months?
If Yes, Name of Institute/Academy: / Year 2009200820072006Pre-2006
If Yes, Name of Institute/Academy: / Year 2009200820072006Pre-2006
11. 2011 International Representation – Vice-Chancellor’s Elite Athlete Grant
Only student-athletes selected or anticipating selection to represent their country in an international eventshould complete this section. International events must be endorsed by an international sporting federation and/or the representative team must be selected by an Australian Sports Commission affiliated sporting organization and/or deemed by Melbourne University Sport to be a legitimate international event.
Selection Status: Please SelectI have been selectedI am awaiting confirmation of my selection
Event:
Date(s): / Location:
Event Sanctioned by:
Sporting Body determining selection:
Event Costs – the $ amount you are required to contribute:$
Letter confirming selection provided as an electronic copy
12. Elite Athlete Status
Applicants wishing to be recognised as an elite athlete as per the University’s Elite Athlete and Performers Policy ( should provide written documentation from:
1. Australian Institute of Sport
2. State Institute of Academy of Sport
3. AFL Players’ Association
4. Australian Cricketers’ Association
5. Rugby Union Players’ Association
6. Rugby League Professionals’ Association
7. Australian Professional Footballers’ Association
8. State or National Sporting Organisation where applicants are team/squad and/or league members from Australian Sports Commission (ASC) supported sports
Letter confirming elite athlete status provided as an electronic copy13. References
Please provide the names and contact details of two referees who can testify as to your sporting achievements
Referee 1: / Relationship: Please SelectCurrent CoachFormer CoachSports Master/PE TeacherClub OfficialState/National AdministratorOther
Phone Contact: / Email:
Referee 2: / Relationship: Please SelectCurrent CoachFormer CoachSports Master/PE TeacherClub OfficialState/National AdministratorOther
Phone Contact: / Email:
14. Personal Statement
Please provide a succinct statement outlining why a Melbourne University Sport Scholarship will assist you in your sporting and academic endeavours.
Receiving a Melbourne University Sport Scholarship will:
15. Privacy Statement
This information is collected, stored and destroyed in accordance with the Melbourne University Sport Privacy Policy. A copy of this document is available at
I have read and understood the Privacy PolicyDate:dd-mm-yyyy
16. Acknowledgement
I acknowledge that the information provided by me (including any attachments) in this application is true and accurate. I understand that Melbourne University Sport reserves the right to amend or terminate the awarding of a scholarship should information provided in this application be false and incorrect.
I acknowledge and submit my applicationDate:dd-mm-yyyy
17. To Submit Application1. Save the document with your Surname as an extension eg. Scholarship_Application_Surname
2. Email the document to .
Note: Vice-Chancellor’s Elite Athlete Grants, Team Melbourne Grants, ScholarFit Grants and Elite Athlete Support applications remain open throughout the year. Applications for High Performance and Friends of the Sports Association Scholarships close on 7 March 2011. Potential applicants are advised to submit applications as soon as possible as available support may be resource-dependent.
18. Further Information
Melbourne University Sport offers a range of scholarships and grants under its Scholarship Program. Applicants should refer to the criteria for each scholarship/grant as outlined in the Sport Scholarship Guidelines available at All applications will be considered against criteria for each of the available Sport Scholarships and/or Grants for the year – hence, applicants do not need to apply for a specific scholarship or grant. Successful applicants will be determined on the information provided.
All Scholarship Program queries should be directed to Rod Warnecke, Sport Development Manager and Elite Athlete Contact Officer P: 03 8344 8891 or E: .
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