Wyndam Richardson Application

Wyndham Richardson Wyndham Richardson Tertiary Students Care Trust Scholarship APPLICATION FORM Wyndham Richardson Tertiary Students Care Trust is offering a number of scholarships for students enrolled fulltime in a Certificate IV or above (AQF) qualification. Scholarships are to the value of $1000.The scholarship will be paid in two $500 instalments provided you are still enrolled and actively participating in full time study. The Wyndham Richardson Scholarships are awarded to students who demonstrate a commitment to study and are in financial hardship. To apply, please complete this form and meet with your campus student services officer for their endorsement of your application. The student services officer will then submit the final application to Felistas Makusha by COB Friday 27th February 2009. NB: Scholarships are only available to Australian Citizens, Permanent Residents and those on the Nominated Visas.

Section 1 - Personal Details Surname:-------------------------------------------

First Name:--------------------------------------------

Address: ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Postcode: ------------------Telephone: (

) ------------------------- ---- Mobile: -------------------------------------------------------

Email: -------------------------------------------------------------------------------------------------------------Gender: Male ˆ

Female ˆ

Date of Birth------------------

Date arrived in Australia (if not a citizen or permanent resident) --------------------------------Australian Citizen ˆ Permanent Resident ˆ Non Permanent ˆ Visa sub-class -----------Fulltime study

Yes ˆ No ˆ (If no please refer to the scholarship criteria for additional information).

Certificate IV or above (AQF) qualification Yes ˆ No ˆ Title of Qualification -------------------------------------------------------------------------------------------------------Note: (If you are an Australian citizen or permanent resident, please attach a copy of your visa or residency status with this form) OFFICE USE ONLY

Received by: --------------------------------------------------------------------Date: ----------------------------------------------------------Applications for this scholarship close on, and will not be accepted after Friday, 27th February 2009. Late applications will not be accepted.

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Wyndham Richardson Tertiary Students Care Trust Scholarship APPLICATION FORM

Section 2 - Educational Background List your qualifications in the table below. In the last column, please indicate whether your past qualifications have been recognised in Australia.

Current or Previous Studies

Qualification e.g. Certificate IV, Diploma, Bachelor, Degree

Subject Area e.g. Chemical Engineering, IT

Educational Institution, City, Country e.g. TAFESA, Port Adelaide

Years of Study e.g. 1998-2000

Recognised Yes/No

Section 3 – Copy of Study Results I have attached a copy of my results (which have been translated into English if necessary) with this application form. Yes ˆ No ˆ Section 4 – Employment Background / Work Experience List any jobs in which you have been/are employed. Job Title Account Manager

Main Tasks e.g. Accounting)

Employer, Country EDS, Australia

Years of Service 12 years

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Wyndham Richardson Tertiary Students Care Trust Scholarship APPLICATION FORM

Section 5 – Financial Status Details 1. Are you independent as classified by Centrelink? (If YES, please complete the LIVING INDEPENDENTLY * income & expenditure for Q3 & Q4). If NO, please answer Q2.

2. Are you living with your parent/guardian/partner? Yes ˆ No ˆ (If YES, is your parent/guardian/partner providing financial assistance for your study?) If YES, please complete the HOUSEHOLD section with your parents/guardians/partners income/ expenditure for Q3 & Q4).If No, please detail all your expenses and income in column 2 (LIVING INDEPENDENTLY *)

3. INCOME details worked out on a FORTNIGHTLY basis. (Please include evidence of a Centrelink financial statement or a copy of your bank statement and three recent pay slips) INCOME (worked out on a FORTNIGHTLY basis)

Salary/Wage before deductions Centrelink:

-

Benefits* Rent Relief Family Payment Parenting Allowance

LIVING INDEPENDENTLY* $

TOTAL NUMBER PEOPLE RESIDING IN HOUSEHOLD** $

$ $ $ $

$ $ $ $

$ $

$ $

$ $

$ $

$

$

LESS

Tax deductions Centrelink deductions Child Maintenance received Other Income (e.g. Austudy Supplement, rent, interest) TOTAL INCOME per fortnight •

Including Youth Allowance, Austudy, Abstudy, Parenting Payment Single, Aged, Disability and Newstart.

4. EXPENSES worked out on a FORTNIGHTLY basis. • •

Please list all ESSENTIAL expenses you will have during the period for which you are enrolled. Only provide Household expenses here if you have Household income as quoted in Question 3.

EXPENSES (worked out on a FORTNIGHTLY basis)

TOTAL NUMBER PEOPLE RESIDING IN HOUSEHOLD**

LIVING INDEPENDENTLY *

Mortgage, Rates & Taxes Rent Board Household: Food, groceries etc. Gas Electricity, Phone (incl. Mobile) Water

$ $ $

$ $

$ $ $ $ $

$ $ $ $ $

Insurance (Health, Building, Contents, Car etc)

$

$

Maintenance/Allowances paid for/to Dependents

$

$

Car maintenance & petrol Public Transport (bus/tram/train tickets)

$ $

$ $

Loan Repayments

$

$

Fees by Instalment

$

$

Credit Card Repayments (Minimum required)

$

$

Other known ESSENTIAL expenses

$

$

TOTAL EXPENSES per fortnight

$

$

5. Total income (from Q3) Less total expenses (from Q4) BALANCE per fortnight

$

$............. $............. $............(This amount to be recorded on application form)

I certify that to the best of my knowledge and belief that the details in this financial statement are true in every particular.

Student Name: ---------------------------------- Signature: ---------------------------------------------------------Date: -----------------------------------

Student Services Officer Signature: -------------------------------

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Wyndham Richardson Tertiary Students Care Trust Scholarship APPLICATION FORM

Section 6 – Commitment to Study (200 word statement) Please complete a statement describing your commitment to study in your chosen career path and how this scholarship would assist. (If preferred, you can type your statement and attach it to the application).

Name: ------------------------------------------------------------------------

REMINDER: The following details must be included with this application: 1 2 3 4 5 6 7

Proof of fulltime study load. Proof of enrolment in a Certificate IV or above course. Copies of qualifications or relevant experience (translated into English if necessary) and; Residency or Visa sub-class - copy if not Australian citizen. Income statement/proof of income. Living Independently How many people in household

Section 7 – Declaration I declare, I am not in receipt of any other scholarship support valued at $500 or more. I agree to TAFESA providing the Wyndham Richardson Tertiary Students Care Trust with my name, contact details and course title, if I am successful in obtaining this scholarship. I also agree to allow TAFESA to follow up on my career progress.

Name: ---------------------------------------

Signature: -------------------------------------------------------

Date: ----------------------------------------Page 4 of 4