Whitley College Bursary, Scholarship and Financial Assistance Application Form 2017

WHITLEY COLLEGE BURSARY, SCHOLARSHIP AND FINANCIAL ASSISTANCE APPLICATION FORM 2017

Whitley College offers bursaries and financial assistance to eligible students experiencing financial hardship. It is our aim to make residence at Whitley College available to students who would otherwise be unable to experience the benefits of living in an academic community. In order to do this fairly, we ask you to consider and fill in these forms with as much detail as possible. Applicants, successful or otherwise, will be notified by the first week of semester.

FAMILY NAME STUDENT NO

GIVEN NAMES DATE OF BIRTH

COURSE NAME FACULTY

YEAR LEVEL STUDY LOAD Full time / Part time

WORKING BURSARIES

If you were to receive a working bursary, which area would you prefer (Please circle):

Kitchen Guests & Accommodation Property maintenance Recycling Classroom setup Library

SCHOLARSHIPS

Scholarships are awarded based on academic achievement and financial needs.

A. Please indicate your 2016 University / School results:

COURSE ATAR SCORE

SUBJECT RESULT SUBJECT RESULT

B. Please list activities (sports, cultural activities, leadership roles, community service, etc) in which you have been involved at University or School during 2015 and any jobs (paid or voluntary) that you hold:

C. If you believe there are any reasons why you should be given special consideration, please state these (eg. personal or family issues; health problems; other disadvantages) FINANCIAL ASSISTANCE

Please detail your proposed income and expenditure for the next 12 months. For assistance with estimating costs, please go to the Financial Aid website: www.services.unimelb.edu.au/finaid/

EXPENSES

WEEKLY EXPENSES FOOD (including snacks) $ TRANSPORT (public transport, petrol, taxis) $ RECREATION (music, movies, theatre, sport etc.) $ PERSONAL (clothing, shampoo, health etc) $ ALCOHOL $ MOBILE PHONE $ OTHER REGULAR COSTS (specify) $ $ $

TOTAL WEEKLY (add up weekly expenses) $

* TOTAL ANNUAL (multiply weekly expenses by 52) $

ONE-OFF COSTS

COLLEGE FEES $ UNIVERSITY FEES $ COURSE MATERIALS (books, equipment etc.) $ TRANSPORT (air fares, car registration, insurance etc.) $ DEBTS (loans, credit cards etc.) $ OTHER ONE-OFF COSTS (specify) $ $ $

* TOTAL ONE-OFF COSTS (add up one-off costs) $

TOTAL EXPENSES $ Add: Total Annual + Total One-off Costs (marked with an asterisk)

FINANCIAL ASSISTANCE

How much financial assistance do you think you will need from the College? $1,000 – $2,000 $2,000 – $4,000 $4.000+ INCOME If you require assistance with estimating wages or benefits, please go to the Careers & Employment website www.services.unimelb.edu.au/careers and the Centrelink website www.centrelink.gov.au EMPLOYMENT

IN WHAT FIELD ARE YOU HOPING TO WORK? JANUARY – FEBRUARY WEEKLY WAGE $ X 9 WEEKS = $ MARCH – NOVEMBER WEEKLY WAGE $ X 39 WEEKS = $ DECEMBER WEEKLY WAGE $ X 4 WEEKS = $ * TOTAL WAGE FOR 52 WEEKS $

OTHER WEEKLY INCOME

CENTRELINK (Austudy, Youth Allowance, Rent Assistance) $ FAMILY CONTRIBUTION $ OTHER (specify) $ TOTAL WEEKLY OTHER INCOME $ * TOTAL ANNUAL OTHER INCOME (Multiply weekly other income by 52) $

LUMP SUMS

SAVINGS (Bank balances) $ FAMILY CONTRIBUTION (e.g. Fees paid) $ OTHER (e.g. Scholarship, bursary etc) $ * TOTAL LUMP SUMS $

TOTAL INCOME $ Add: total wages + total of 52 weeks other weekly income + lump sums

ASSETS (LIST APPROXIMATE VALUE)

VEHICLE $ OTHER (please specify) $

DECLARATION

All applicants must read, sign and date this declaration:

I declare that the information I have provided in this Application form is true and accurate. I am aware that misleading or non-disclosure of information may jeopardise my application. I agree to provide supporting documents of financial information and relevant evidence if requested.

SIGNATURE OF APPLICANT: DATE:

NAME OF WITNESS: (Witness is to be a person other than a family member residing in the family home) SIGNATURE OF WITNESS: DATE:

Whitley College Privacy Policy The information you provide on this application is required to assess the appropriateness of the Whitley College financial support package to your identified needs and preferences. Your application will be provided to the Warden and Business Manager of Whitley College. STATEMENT OF PARENTS’ OR GUARDIANS’ INCOME

STATEMENT OF INCOME (to be filled in by Parent of Guardian. If parents are separated but both parents are contributing financial support to the applicant, then both parents should complete a Statement of Income form, in which case you will need to make another copy of this form) I ……………………………………………………………………………………………………………………………………………………………………………….. Of (address)…………………………………….………………………………………………………………………………………………………………………… In the State of …………………………………… HEREBY DECLARE: (a) I am the father/mother/guardian of……………………………………………………………………………………………………………………..

who is an applicant for financial assistance from Whitley College. (b) My gross income for the financial year ended 30th June 2016 amounted to: $...... (c) My taxable income for the same period amounted to: $...... (d) My spouse’s gross income for the financial year ended 30th June 2016 amounted to: $......

(e) My spouse’s taxable income for the same period amounted to: $...... (f) Please state the reason(s) if details of spouse’s income are not provided:…………………………………………………………….

………………………………………………………………………………………………………………………… ………………………………………………………. (g) Assets (List approximate value) House $...... Shares/Investments $...... Vehicle $...... Other $......

(h) Please note any other relevant information regarding financial assistance for your son/daughter/ward: …………………………………………………………………………………………………….. …………………………………………………………………………… ………………………………………………………………………………………………………………………. …………………………………………………………. ……………………………………………………………………………………………………………………….. ………………………………………………………… ……………………………………………………………………………………………………………………….. ………………………………………………………… ……………………………………………………………………………………………………………………….. ………………………………………………………… I solemnly and sincerely declare that the several statements and answers to the questions made in this document are true and correct in every particular. And I make this solemn declaration conscientiously believing the same to be true. I agree to provide supporting documents of financial information and relevant evidence if requested.

NAME OF DECLARANT:

DATE: SIGNATURE OF DECLARANT:

NAME OF WITNESS: (Witness is to be a person other than a family member residing in the family home) SIGNATURE OF WITNESS: DATE:

SUBMITTING YOUR APPLICATION

Please return this form to the Warden, Margie Welsford, no later than Friday 27th January 2017 CHECKLIST Tick to ensure you have provided and completed the following:  Signed student declaration with witness  Signed parents’ declaration with witness OPTIONAL EXTRAS  Additional supporting documentation/letters  Extra information if you ran out of space answering a question