Part a Application Form
STUDENT APPLICATION PACK
PART A – APPLICATION FORM
(Tip: Please save this application form to your computer hard-drive to complete electronically)
The Premier’s Anzac Prize 2018 will give eight students a once in a lifetime opportunity to experience the Anzac tradition firsthand. The prize includes a tour to the United Kingdom (London), Belgium and France in April–May 2018 and includes travel, group travel insurance, accommodation and meals. Students will attend ceremonies marking Anzac Day at Villers-Bretonneux in France and across the Western Front as well as experience many of the tourist attractions. For further information about the itinerary, please refer to the 2017 tour page for an example itinerary: http://education.qld.gov.au/students/grants/scholarships/anzac/2017.html. Two chaperones will be selected to lead and accompany the selected students. The application package has six parts [A-F].
Privacy Notice
The Department of Education and Training (the Department) is collecting personal information on this form, including names, contact details, photographs and medical information for the purpose of administering The Premier’s Anzac Prize 2018, assessing applications for The Premier’s Anzac Prize 2018, verifying information provided and contacting applicants, parents and endorsing principals/teachers where necessary (for example, to request further information). The information submitted on this form will be made available to employees of the Queensland Government involved in administering The Premier’s Anzac Prize 2018.
Entries will be shortlisted by an evaluation committee comprising of employees of the Department and other persons (for example, the chaperones selected for the tour, non-state school teachers and representatives from universities across Queensland). A selection panel, including a serving member of the Australian Defence Force and an Anzac descendant will review the shortlisted entries to determine the winners. The evaluation committee and the selection panel will be provided with the applicant’s name, school and multimedia presentation only.
In relation to shortlisted entries (finalists) -
Some of the information provided by these applicants (including name, school, year level, photographs and responses to background information below), will be used to create a short biography about each finalist.
In relation to the winners
The biography referred to above will be disclosed to the Minister of Education (‘the Minister’), the Premier, and their staff and made public. For example, the biography will be put in a media release, given to media organisations and may be put on the internet.
Student/parent/guardian contact details may be provided to the Minister and the Premier and their staff and Members of Parliament, for the purpose of them contacting the winners about the Prize.
Parent/guardian contact details may be provided to media representatives for the purpose of them contacting the parents/guardians about the students and the Prize. The parent/guardian will always be the first point of contact for the media representative. A parent/guardian holds the decision of whether to allow the media to directly communicate with the student.
The winning multimedia presentations may be provided to the Minister, the Premier, their staff, the chaperones and the Department staff involved in administering The Premier’s Anzac Prize 2018.
The personal information provided will be used for planning and organising The Premier’s Anzac Prize 2018 tour (which is the prize), obtaining travel insurance, making arrangements to cater for special requirements (where possible) and for the purpose of assisting the Department and chaperones to fulfil their duty of care. This information will be given to supervising staff and chaperones accompanying the overseas tour. Some of the information provided will be disclosed to insurance organisations, tour operators, airlines, travel companies, accommodation providers and other external parties involved in providing services to the group as part of the tour. Relevant information will be given to medical professionals in the event the student requires medical attention on the tour or while in the care of the Department.
The personal information and copyright material will also be dealt with in accordance with the Consent Form (Part D).
The information will not be used or disclosed for any other purpose without your consent unless the use or disclosure is required or authorised by law. If you have any questions or concerns about the collection, storage, use or disclosure of the information, please contact the Senior Project Officer on 3513 5747.
1. Student details (the applicant) As per your passport or birth certificate.Surname: / PASTE
PASSPORT PHOTO HERE
(or a recent photo of yourself)
Given names:
Sex: / Male Female
Date of birth: / Day / Month / Year
Citizenship: / Australian citizen Australian permanent resident
New Zealand citizen residing in Australia
Please note, the Department may request more information regarding your residency status.
Do you have a current passport with validity up to 31 December 2018?
Successful applicants can organise the required passport when they are notified they are a winner / Yes No
My multimedia presentation is in the following format: / mov mp4 wmv
Multimedia references: / I have attached a list of references
2. Contact Details
Home address:
Postal address:
(if different from above)
Home phone: / Mobile (student):
Parent 1 name: / Parent 2 name:
Mobile (parent 1): / Mobile (parent 2):
Work phone (parent 1): / Work phone (parent 2):
Email (parent 1):
Email (parent 2):
Email (student):
3. School details (if home educated, please complete Question 6 below)
I am currently enrolled (in 2017) as a student in: / Year 8 9 10 11
Name of school:
Full address of school:
School phone:
School type: / State Catholic Independent Other
Endorsing Teacher’s name: / Teacher’s phone:
Teacher’s email:
Principal’s name: / Principal’s phone:
Principal’s email:
4. Teacher’s endorsement
Teachers, please consider the student’s school attendance record, behavioural and discipline history, contribution as a member of the school community and the student’s multimedia presentation when providing your endorsement for their application to represent your school and Queensland in The Premier’s Anzac Prize 2018.
[Teacher to insert own comments here]
Furthermore, I have viewed the student’s presentation.
Teacher’s signature: / Date:
5. Principal’s signature (please note: each school may nominate up to two students)
I am aware only two applications from my school will be accepted and I support this student’s application.
Principal’s signature: / Date:
6. Home educated students (only required for home educated students)
Please indicate your year level (as recorded in the Home Education Unit database, based on your age not the content of the home education program): Year 8 9 10 11
Referee’s report
Please provide a statement of endorsement. This endorsement must be provided by someone over the age of 18 years who has known the applicant for at least 12 months and is not a member of the applicant’s immediate or extended family. The referee must be in a position to attest to the applicant’s character.
[Referee to insert own comments here]
How is the applicant known to you?
Name of referee: / Contact no.:
Signature of referee: / Date:
Signature of parent: / Date:
OFFICE USE ONLY
Home Education Registration - ConfirmationThe Department will confirm with Manager, Home Education Unit, that applicant is registered for home education and the year level of the student.
Registered for home education ¨ Year level confirmed ¨
7. Special requirements
Please consider the information you have provided and all information about the tour and provide details of any special requirements you may have for the tour if your application is successful. For example: adjustments for impairment; mobility aides or assistance; religious requirements; medical conditions; dietary requirements (such as allergies, halal, vegetarian, gluten free); any special requirements for air travel or accommodation. If you do not have any special requirements, please indicate N/A below. Further information may be requested to assess if and/or how your special requirements can be accommodated on the tour.
8. Do you identify with any of the following groups Aboriginal, Torres Strait Islander or non-English speaking background?
No Yes
Please provide details:
9. Background Information:
(please answer all questions and provide relevant detail)
Do you have any family links to Anzac or the Australian Defence Force?
What is your inspiration for entering The Premier’s Anzac Prize 2018?
Have you been to the United Kingdom (London) or the Western Front before?
What are your hobbies or interests?
What is your career goal?
Do you participate in any community activities? (Please detail)
Is there any event or experience that has shaped your perception of Anzac Day? (Please detail)
What would you hope to learn from a tour to the United Kingdom (London) and the Western Front?
How would you use the Premier’s Anzac Prize experience to influence your local community?
I declare that:
· I have read and understood the privacy notice on page 1 of this application form
· I have read, understood and agree to the conditions of entry [Part B]
· I have read and understood the tour rules [Part C] and if I am selected for the tour I agree to comply with the tour rules
· I have read the Student Code of Conduct [Part D] and if I am selected for the tour I agree to abide by the code [Part D]
· I have read, understood and signed the consent form [Part E]
· I am an Australian citizen, permanent resident of Australia, or New Zealand citizen residing in Australia
· The presentation I submit is my original work and has not been professionally developed or edited by any other person
· My presentation does not contain material owned by other people (e.g. music) without their permission
· All information provided in this application form is true and accurate to the best of my knowledge
· I am available to travel in April and May 2018
· I am medically fit to travel and will inform the organisers if my health changes such that I am not medically fit to travel
· I am not a previous recipient of The Premier’s Anzac Prize (Queensland).
_______________________________________________ ____________________
Applicant signature Date
PART B - CONDITIONS OF ENTRY
Who can enter?
The Premier’s Anzac Prize is open to all eligible Year 8–11 Queensland students. For students registered for home education, their year level is the year level recorded in the Home Education Unit database, based on their age, not the content of the home education program.
Year 8–11 Queensland students are eligible if, at the time of application and at the time of travel (April and May 2018) they are:
· an Australian citizen, a permanent resident of Australia or a New Zealand citizen residing in Australia
and either:
o a student at a Queensland state school or accredited Queensland non-state school who has been nominated by their school or
o registered for home schooling in Queensland.
Each state school or accredited non-state school may nominate up to two students only. Entries must be from individuals and not groups.
How do students enter?
Students are invited to submit a multimedia presentation addressing the following key question:
Students are asked to refer to evidence of the Anzac spirit from Australia’s involvement in wars and conflicts from Gallipoli through to the present day, and to relate those experiences to positive values and activities in everyday life.
Students are encouraged to source material from interviews, experiences of friends or relatives, media resources and individual research. All sources must be acknowledged and referenced. The presentation must include a list of references which acknowledges all of the material students use.
The multimedia presentation must be between three and five minutes long, in one of the following formats: mov, mp4 or wmv. Other formats will not be accepted.
Multimedia files will not be accepted unless they are less than 100Mb in size (preferably less than 10Mb). If students need to reduce the size of the file to be less than 100Mb, consider using a software program that enables reduction of the file size (e.g. Xilisoft Video Converter, Camtasia etc)
When can students enter?
Applications open on 18 April 2017 and must be received by the Queensland Department of Education and Training (the Department) by 5pm, 15 September 2017. Late applications will not be accepted. Early lodgement is welcome.
Winners will be announced by the end of the 2017 school year.
Entry procedures
Students must submit the following:
· a multimedia presentation with a list of references
· a completed and signed application form [Part A]
· a completed and signed consent form [Part E] (this form must be signed by the student and parent)
· a completed and signed parent’s agreement [Part F].
Entries that do not include all the above components will not be considered.
The multimedia presentation must be submitted on USB.
Save the signed and scanned documents onto the same USB
Include original hard copy of application form in envelope with USB.
The USB must be sent to:
The Premier’s Anzac Prize
Department of Education and Training
International Services
PO Box 15050
CITY EAST QLD 4002
Judging criteria and process
Entries will be assessed against the following criteria:
· addresses the key question effectively
· adheres to the set time limit of three to five minutes
· includes one or more examples of Australia’s involvement in conflicts to illustrate the Anzac tradition
· argues a point of view effectively while recognising changes in people’s approaches to historical events over time
· uses a range of historical sources and evidence to support ideas
· evaluates historical sources in the inquiry
· uses the features of the medium to communicate the argument and the analysis effectively and purposefully
· includes references in presentation.
Applications will be shortlisted by an evaluation committee comprising employees of the Department and other persons (for example, non-state school teachers and/or representatives from universities across Queensland). A selection panel including a serving member of the Australian Defence Force and an Anzac descendant will determine the final eight students.
The eight winners will be announced by media release.