2016 APPLICATION FORM The Australian Psychological Society bursary of Financial Assistance for People of Aboriginal and Torres Strait Islander Descent:
The Bendi Lango bursary
The closing date for applications is Friday 1 April 2016.
Please attach: A letter confirming your Aboriginal and/or Torres Strait Islander heritage Documents demonstrating your financial position Copy of academic transcript and proof of acceptance/enrolment into postgraduate degree Completed Community Referee Report Completed Academic Referee Report
To: Email: [email protected] Post: The Administrator, Science and Education The Australian Psychological Society Ltd PO Box 38 Flinders Lane VIC 8009
Enquiries: Email: [email protected] Phone: (03) 8662 3300
Updated: 17 November 2015 1. Information about the applicant
Title: ...... First Name: ...... Family Name: ......
Address: ......
Telephone: ...... Mobile: ......
Email: ......
APS membership grade Membership (if applicable): number: ......
2. Confirmation of Aboriginality
Please attach a letter of Aboriginal and/or Torres Strait Islander heritage by an Indigenous organisation who has a common seal of certification. (Other proof of heritage may be considered at the discretion of the Selection Committee)
Name of organisation: ......
Address: ...... Telephone: ......
Email: ...... 3. Personal statement
Please complete the three sections below:
Q1: Please comment on the contribution you have made to your community and the broader community to date (max. 300 words)
Q2: What are your planned future contributions to your community and the broader community? (max. 300 words)
Q3: What would the receipt of financial assistance from the APS mean to you? (approx. 100-150 words) 4. Financial statement
In acknowledgement of the hardship faced by many people of Australian Aboriginal and Torres Strait Islander descent, the APS has established the Bendi Lango bursary for the purpose of offering funding to alleviate some of these financial concerns. Donations to the APS fund set up for this bursary are tax deductible. Therefore, the Australian Taxation Office requires us to ask you for some evidence of your 'necessitous financial circumstances'. These are defined as 'circumstances where an applicant’s financial resources are insufficient to obtain all that is necessary for a modest standard of living, which is a standard of living greater than bare existence'.
Please attach a statement of your financial position
Please include any or all of:
(i)A statement of your monthly income and outgoings
(ii)A copy of your most recent tax return
(iii)The basis on which you have been assessed as qualifying for social welfare, if applicable (e.g. Healthcare card, Abstudy/Austudy, Centrelink benefit)
(iv)Any other circumstances which may be causing you financial hardship. 5. Education details
Please attach a copy of your academic transcript(s) to date, as well as proof of offer and acceptance, or enrolment, in an APAC-accredited postgraduate psychology coursework degree
Undergraduate course details:
......
Years of study: ......
Details of proposed/current postgraduate course:
......
6. Community referee
Please attach the completed Community Referee Report Form (Attachment A) (The Selection Committee recommends that the report come from an individual or organisation familiar with your community contributions)
Name of community referee: ......
Contact number: ......
Email: ......
7. Academic referee (For example: Academic supervisor / Director or Staff of Indigenous Centre)
Please attach the completed Academic Referee Report Form (Attachment B)
Name of academic referee: ......
Contact number: ......
Email: ...... Signature of Candidate:
Print name: Date:
The closing date for applications is Friday 1 April 2016.
The completed application form with required attachments should be emailed to: [email protected].
Alternatively, all documentation can be sent to:
The Administrator, Science and Education Australian Psychological Society PO Box 38 FLINDERS LANE VIC 8009 Attachment A – Community Referee Report
As part of the application for the Bendi Lango bursary, Candidates must provide a reference, preferably from an Aboriginal or Torres Strait Islander community controlled organisation. This reference will be treated as confidential. Please complete this form and return it directly to the Candidate to attach to their Bendi Lango Application form. If you have any queries about completing this form, please contact Nicole Feast, Science and Education Coordinator, at [email protected] or on (03) 8662 3362.
Candidate Details (Candidate to complete)
Title Mr / Mrs / Miss / Ms Surname Given Names Course of Study and University
Community Referee Details (Referee to complete)
Title Mr / Mrs / Miss / Ms / Dr / Professor Surname Given Names Name of Organisation Position within Organisation Address of Organisation
Contact Number Email Address
Community Reference (Referee to complete)
Does the Candidate actively identify as an Yes / No Aboriginal or Torres Strait Islander person? Does the community in which he or she Yes / No lives accept the applicant as an Aboriginal or Torres Strait Islander person? In what capacity do you know the Candidate?
For how long have you known the Candidate?
Q1: In what ways has the Candidate demonstrated involvement and commitment to the Indigenous community?
Q2: In what ways do you believe the Candidate will contribute to his or her community in the future?
Q3: What are the outstanding qualities of the Candidate, and how might they contribute to his or her future career in the field of psychology?
Q4: Why do you believe that the Candidate should be awarded the Bendi Lango bursary?
General comments:
Please attach additional pages if more space is required
Signature of referee:
Print name: Date:
Upon completion of this report, please return it to the Candidate. Attachment B – Academic Referee Report
As part of the application for the Bendi Lango bursary, Candidates must provide an academic reference. This reference will be treated as confidential. Please complete this form and return it directly to the Candidate to attach to their Bendi Lango Application form. If you have any queries about completing this form, please contact Nicole Feast, Science and Education Coordinator, at [email protected] or on (03) 8662 3362.
Candidate Details (Candidate to complete)
Title Mr / Mrs / Miss / Ms Surname Given Names Course of Study and University
Academic Referee Details (Referee to complete)
Title Mr / Mrs / Miss / Ms / Dr / Professor Surname Given Names Name of Institution Position within Institution Address of Institution
Contact Number Email Address
Academic Reference (Referee to complete)
Q1: For how long have you known the Candidate, and in what capacity?
Q2: What was the topic of the Candidate’s Honours thesis (if known)?
Q3: How would you describe the past academic results and academic potential of the Candidate?
Q4: What personal attributes does the Candidate possess that might contribute to his or her future career in the field of psychology?
Q5: Why do you believe that the Candidate should be awarded the Bendi Lango bursary?
General comments:
Please attach additional pages if more space is required
Signature of referee:
Print name: Date:
Upon completion of this report, please return it to the Candidate.