ECU SCHOLARSHIPS OFFICE

REQUEST FOR PART-TIME APPROVAL FORM

/

PLEASE PRINT CLEARLY IN BLACK INK

STUDENT NUMBER: / DAYTIME CONTACT PHONE NUMBER:
SURNAME/FAMILY NAME: / GIVEN NAME/S:
POSTAL ADDRESS: / POSTCODE:

Have you previously applied for part-time approval YesNo

SCHOLARSHIP DETAILS(please specify which Scholarship(s) this application applies to)

REASON FOR REQUEST

Please summarise the ExceptionalCircumstances that have impacted on your ability to study full-time.
Please attach documentation supporting your claim.
Have you attached original or certified copies of documentation supporting your claim? Yes  No 

STUDENT DECLARATION

I declare that the information supplied on this form and the information given in support of my application is correct and complete. I acknowledge that the provision of incorrect or misleading information or the withholding of relevant information to my application may result in the cancellation of my scholarship.
Signed: Date:

Part-time Approval

If you are in receipt of a Scholarship which requires you to study full-time (45+ credit points), and, in Exceptional Circumstances, you need to drop from full‐time to part-timestudies you should contact the Scholarships Office to advise them of thesecircumstances and apply for Part‐time Approval by completing this form. ExceptionalCircumstances relates to situations that are out of your control such a suddenillness or family issue OR a change in the course structure, it does not cover thingssuch as parental or work responsibilities. You will be asked to provide supportingdocumentation to prove your Exceptional Circumstances, such as a medicalcertificate or counsellor’s letter.

Supporting Documentation

You must attach independent supporting documentation (original or certified copies) from a relevant authority (e.g. doctor, counsellor, course co-ordinator) to your application. “Independent” means it should not be from your family or friends. Privacy laws preclude us from obtaining information on your behalf so you are responsible for providing evidence to support your claim. The University is bound by law to protect your privacy therefore any information you provide in relation to this application will only be used for the purpose intended.

Decisions

You will be advised via your ECU Student email of the outcome of your application. If your application is successful, the confirmation email will advise you of the approved period for part-time study relating to your Scholarship. If your application is unsuccessful the University will provide you with information about requesting a review of the decision. This must be done in writing within 28 days of receiving the original decision.

Please submit completed application to Student Central or,

Scholarships Office via a scanned copy to or, via mail to:

Scholarships Office, ECU Joondalup, 270 Joondalup Drive, JOONDALUP WA6027

OFFICE USE ONLY

SCHOLARSHIPS OFFICE Received on: Received by:
Recommending Officer: / Recommendation: Yes  No 
Comments:
Senior Scholarships Officer: / Outcome: Approved  Not Approved 
Approval: 6 months  12 months  Ongoing 
Comments:
Student Notified by: / Date:
Additional Comments:
Document scanned against student record by: / Date: