Signature of Applicant: - Edith Cowan University



Humanitarian ScholarshipApplication FormImportant informationAll sections on the application form must be completed and it is the responsibility of the applicant to provide relevant supporting documentation at the time of submission or the application may not be considered. Applicant DetailsFirst Name:Click here to enter text.Surname:Click here to enter text.Preferred Name:Click here to enter text.Student ID: Click here to enter text. Contact Phone no: Click here to enter text.Student Email:Click here to enter text.Please ensure that your correspondence address details are updated on SIMOHave you applied for admission and accepted an offer for an ECU undergraduate Bachelor degree course commencing this semester??Yes ?No – Sorry you are not eligible for this scholarshipAre you enrolled in a minimum of 30 credit points (usually 2 units)??Yes ?No – Sorry you are not eligible for this scholarshipIf offered the scholarship would you be willing, at the end of the academic year, to write a statement describing how you used the funds? ?Yes ?No – Sorry you are not eligible for this scholarshipAre you a refugee or the first generation descendant of a refugee? ?Yes?No – Sorry you are not eligible for this scholarshipApplicants must be a refugee or the first generation descendant of such a person, who experienced forced migration and may have entered Australia in a number of ways5.Please indicate which response relates to you ?I am a refugee ?I am a first generation descendant of a refugee because one or both parents entered Australia as a refugee. Which of the following best describes how you and / or your parent/s entered Australia??Off-shore approved Refugee or Humanitarian entrant ?Onshore, community based Asylum Seeker or refugee ?Temporary Protection Visa holder ?Family Reunion ?Other – Please provide Country of Origin: Click here to enter text.Date Entered Australia as refuge: Click here to enter text.Please indicate which is your current nationality/visa status ?an Australian Citizen ?the holder of an Australian Permanent Humanitarian Visa ?the holder of An Australian Permanent Resident Visa Financial and Personal CircumstancesDo you have a disability or ongoing illness that significantly affects your ability to study?If yes, please provide brief details Click here to enter text.?Yes ? NoAre you the primary carer for someone with a disability, special needs or ongoing illness? If yes, please provide brief details Click here to enter text.?Yes ?No Are you currently in receipt of any other scholarships or awards? If yes, please provide name of scholarship and semester valueClick here to enter text.?Yes ?NoPlease provide information about your current personal and living circumstances by marking with a ‘x’ those responses most relevant to you/your situation.Single ?Living with parent/guardian/relative/partner?Single with dependents ?Living in shared accommodation?Partnered with no dependents ?Working full time?Partnered with dependents?Working part time?In receipt of single or partnered parenting payment?In receipt of Youth allowance or Austudy?In receipt of Disability Support Pension or Carers allowance/payment?In receipt of Rental assistance from Centrelink?Number of adults (18 years old and over) in the home?Number of Children (17 years old and under) in the home?What is your fortnightly income?Amount $Your personal fortnightly Salary/Wages (nett/take home pay)$ Click here to enter text.Your Fortnightly Centrelink payments/allowances$ Click here to enter text.Other financial assistance you personally receive$ Click here to enter text.If you live with other adults please provide the total family/household Income$ Click here to enter text.Please describe your current financial situationClick here to enter text.Please provide information relating to you and your families personal and financial circumstances, past and/or present which have a significant impact on your life Click here to enter text.Please provide a statement outlining your personal goals or what you hope to achieve upon completion of your studies and how this scholarship will help you achieve these goals.Click here to enter text.Checklist – Please tick to indicate that you have attached the following supporting documentation to this application form. Failure to provide supporting documentation may affect you receiving a scholarship offer. 16. ?Evidence of Citizenship or residency status (copy of certificate/visa/passport) attached Applicants of the Humanitarian Scholarship must attach evidence of theirs or their parent’s refugee status when submitting their application.We will accept copies of official documentation provided by the Australian Government – Department of Immigration and border Protection showing entry to Australia on a refugee or humanitarian visa including ‘Document for travel’ and Australian Visa’s for yourself and / or your parents.Please list what documentation you have attached as evidence of you refugee status.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Please note: - If any of the relevant parties are known under a different name to that on their immigration documents then further evidence of the name change will need to be provided18. ?Evidence of name change attached19.Where did you hear about this scholarship?Click here to enter text.Student Declaration I declare that the information I have supplied within this application is true and correct to the best of my knowledge. I understand if any false or misleading information is provided it could lead to the cancellation of my scholarship. I also understand giving false or misleading information is a serious offence under the Criminal Code. I consent to the disclosure of relevant information for the selection process of this scholarshipSignature of Applicant: Click here to enter text.Date: Click here to enter a date. ................
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