<p>2018 Higher education scholarship application</p><p>Applications must be received by 4.00pm on Friday 9 March 2018</p><p>Please read the 2018 Higher Education Scholarship eligibility criteria and terms before completing this form https://nt.gov.au/learning</p><p>2018 Higher education scholarship application Personal details Family name Date of birth Given name(s) Male Female Residential address State Post code Postal address State Post code Home phone Mobile phone Phone contact Email address* during term *All correspondence including attachments will be sent to this email address Nominated contact person (for example, parent, guardian, relative) to receive requests and provide information regarding this scholarship if required Name Relationship Residential address Suburb State Post code Home phone Work phone Email address Mobile phone Length of residency in the Northern Territory years</p><p>Are you an Australian Citizen? (if ‘No’, proof of permanent Yes No residency) Are you of Aboriginal or Torres Strait Islander descent? Yes No </p><p>Are you from a non-English speaking background? Yes No If ‘Yes’, what is your first language spoken at home? Do you have a disability? If ‘Yes’, please briefly describe Yes No </p><p>Education information - a copy of your results must be attached What high school did you complete Year 12? What year did you complete Year 12? 2016 2017 </p><p>Department of Trade, Business and Innovation Page 1 of 3 November 2017 2018 Higher education scholarship application Northern Territory Board of Studies Higher Education Entrance Information - Australian Tertiary Admission Rank (ATAR) score or International Baccalaureate Other financial assistance </p><p>Have you applied for any other scholarships or grants, or will you receive Yes No study assistance from any other source? If ‘Yes’, please advise details. Source / details</p><p>Will the other assistance be paid directly to you or to the university for course fees or accommodation costs.</p><p>Amount ($ per annum) When will you be notified that your application for other assistance has been successful or not? University enrolment - a copy of the course enrolment must be attached Name of university Address Course name Course major Course code Length of full-time course I am enrolled to study interstate and grant permission for the Scholarships Administrator to provide my course information to Charles Darwin University (CDU). The Awarding Panel, Department and CDU will determine if the course I am studying is significantly different to that available in the NT. Application check list - your application will not be assessed unless the following information is attached (please do not send original documents) Proof that you live in the Northern Territory (for example, copy of driver’s licence or a bank statement with residential address). Proof of Australian citizenship or permanent residency (birth certificate, passport or immigration document). Proof that you have completed the NTCET or equivalent. Proof of 2016 or 2017 ATAR or IB. Confirmation of university enrolment for semester 1, 2018 which shows your name, the name of the university and the units you are enrolled in. Personal Statement, page 3 of application Personal statement Name</p><p>Department of Trade, Business and Innovation Page 2 of 3 November 2017 2018 Higher education scholarship application Outline how the scholarship will assist you, what career path you wish to take and if you intend to work in the Northern Territory after graduation. If studying interstate tell us:  why you chose the course and the course differences and expected outcomes to that available in the NT</p><p>Declaration I completed the NTCET or IB in the NT in 2016 or 2017. I have read and understand the Northern Territory Government eligibility criteria and terms of the 2018 Higher Education Scholarship. I certify that I meet the eligibility criteria and my application is within the terms and conditions and I intend to continue to meet the terms and conditions if granted a scholarship. I understand that a breach of the terms and conditions could lead to withdrawal of the scholarship and in certain circumstances recovery of monies paid under the scholarship. I declare that the information contained in this application and attachments is, to the best of my knowledge, true and correct.</p><p>Signature Date</p><p>For further information email [email protected] or telephone the Scholarships Administrator on (08) 8935 7706.</p><p>If the Scholarships Administrator requests further information to support your application a date will be advised for the information to be received. If the information is not received by the set date the application will be deemed ineligible.</p><p>Email your application and supporting documents to [email protected]</p><p>Applications close at 4.00 pm on Friday 9 March 2018. Late applications will not be accepted.</p><p>The NT Government is collecting this information for the administration of the Northern Territory Government Scholarships. Only authorised officers have access to this information. Your personal information will not be disclosed to any other third party without your consent, unless authorised or required by law, in accordance with the Information Privacy Principles.</p><p>Department of Trade, Business and Innovation Page 3 of 3 November 2017</p>