Yulendj Indigenous Engagement Unit

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Yulendj Indigenous Engagement Unit

Monash Indigenous Pathway Application Form

This form permits the Yulendj Indigenous Engagement Unit to track your Indigenous Non-Award Pathway (INAP) or Indigenous Enabling Program (IEP) application and advocate on your behalf in the selection and admission process.

PERSONAL DETAILS

Title / Given Name / Family Name
Date of Birth / Gender
Home address / Street
Suburb / State / Postcode
Postal address / Street
Suburb / State / Postcode
Mobile / Home / Work
Fax / Email
I identify as being of Aboriginal and/or Torres Strait Islander descent

EDUCATION DETAILS

List all previous study details and include information regarding an existing application, if relevant.
Course Title
(Eg. Year 10/VCE/Cert. IV Business Admin) / Course Duration
(Month/year – month/year) / School/Institution/Provider / Completed?
(Overall score/average)
I have recently submitted an application through VTAC / VTAC ID Number (if known)
I have previously applied to/studied at Monash University / Monash ID Number (if known)

COURSE PREFERENCES

List each course added as a preference on your VTAC/direct application.
Course Code / Course Title / Campus / Mode
1.
2.
3.
4.
5.
6.

EMPLOYMENT DETAILS

Position Title / Period (year) / Employer/Organisation / FT/PT

VOLUNTEER OPPORTUNITIES

Position Title / Period (year) / Employer/Organisation / FT/PT

OTHER QUALIFICATIONS

List other relevant qualifications (Industry/community/sporting awards)
Qualification/Award Title / Awarded by / Year

ADDITIONAL INFORMATION

Please tell us about any other achievements (personal or professional) that you feel are relevant to your application (Eg. Leadership roles, sporting and cultural achievements)
(attach more pages if required

Please tell us your reasons for wishing to undertake study in your chosen course/s

(attach more pages if required

Declaration

The information on this form is collected for the primary purpose of tracking and supporting applications of Indigenous students to the degree/diploma courses in the faculties of Monash University. Other purposes of collection include consulting with faculties about your application. If you choose not to complete all the questions on this form, it may not be possible for the Yulendj Indigenous Engagement Unit to track and support your application. You have a right to access personal information that Monash University holds about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal information, please contact the University Privacy Officer on 9905 6048.
I declare that I am Aboriginal and/or Torres Strait Islander and that the information provided in support of my application is correct and complete. I recognise that it is my responsibility to provide all necessary documentary evidence in support of this application and acknowledge Monash University reserves the right to seek verification of these claims from other relevant bodies.
Signature / Date
Please return this form to:
§  Email

§  Postal
Yulendj Indigenous Engagement Unit
Building 55, Clayton Campus
MONASH UNIVERSITY VIC 3800 / For enquiries regarding this course or application form:
Ms Kristel Keleher
Room 117, Building 55
Monash University, Wellington Road, Clayton
Telephone: +61 3 9905 8699
Mobile: 0428 323 465
Email: