The Woss Family Jazz and Music Theatre Scholarships Application Form All sections on the application form must be completed and supporting documentation must be provided where indicated otherwise the application may not be considered. Applicant Details Student No: First Name: Click here to Surname: Click here to enter Click here to enter text. enter text. text. Date of Birth: Click here to Gender: Male ☐ Female ☐ enter text. Current Address: Click here to enter text.
Suburb Click here to enter text. Postcode Click here to enter text. Permanent Home Address: (If Click here to enter text. different from above) Suburb Click here to enter text. Postcode Click here to enter text. Home Phone: Click here to Mobile: Click here to enter text. enter text. Please ensure that your correspondence address details are updated on SIMO 1. Are you an Australian Citizen ☐ or A Permanent Resident ☐ 2. Are you studying full time in on campus units? ☐Yes ☐ No
3. What year of which course are you enrolled in?
2nd Year ☐ 3rd year ☐
Bachelor of Music (Jazz) course ☐ Bachelor of Arts (Music Theatre) ☐
Financial and personal Circumstances 4. Are you of Australian Aboriginal or Torres Strait Islander descent? ☐Yes ☐No
5. Do you have a disability or ongoing illness that significantly affects your ability to ☐Yes ☐No study?
6. If you have a disability or ongoing illness, are you registered with the ECU Equity ☐Yes ☐No Diversity and Disability Office?
7. Do you provide care for any person with special needs or ongoing illness? ☐Yes ☐No
8. Are you personally in receipt of a means tested allowance from Centrelink or ☐ Yes – the Department of Veterans Affairs? Complete Q8B & Q8C 8b.If yes, please identify the allowance below Click here to enter text. ☐ No – And go to Q9 8c. complete the Centrelink Consent form and attach to your application
9. If you are not in receipt of a Centrelink allowance please outline any reasons why you may be financially disadvantaged Click here to enter text.
10. Are you in receipt of a valid current Health Care Card? ☐Yes ☐ No 11. What other personal or family income (if you are dependent on your family’s income) do you receive per fortnight? Gross Average Fortnightly Income Amount $ Salary/Wages (gross) $Click here to Assistance from family $enterClick text. here to Child Support $enterClick text. here to Other (e.g. shares, investments, bank interest, etc.) $enterClick text. here to Total $enterClick text. here to enter text.
12. What are your gross average fortnightly expenses? Fortnightly Expenses Amount $ Rent/Board/Mortgage $Click here to enter Food/Groceries $text.Click here to enter Phone, Power, Utilities $text.Click here to enter Transport (Transperth, car costs including insurance, registration, etc.) $text.Click here to enter Childcare $text.Click here to enter Loan Repayments $text.Click here to enter Incidentals/Other $text.Click here to enter Total $text.Click here to enter text.
13. Please identify your living situation Single (living with parents/guardians/family members) ☐ Single (living away from home/financially supported by parent/guardian) ☐ Single(living away from home/financially independent) ☐ Single with dependants ☐ Partnered with no dependants ☐ Partnered with dependants Other (please describe) ☐ ☐ 21. Personal Statement
Please attach a personal statement (Max 2 x A4 sides) describing
Your circumstances either past or present, which have had an impact on your life and capacity to give time and attention to your studies
How you would personally benefit from the scholarship, if you were to receive it?
22. References/referees
Please attach two written references with the names and contact details of the referees
23. Brief resume Please attach a brief version of your resume (maximum of 2 sides A4 page)
24. Checklist – Please tick to indicate that you have attached the following supporting documentation to this application form. Failure to provide supporting documentation may affect you receiving a scholarship offer.
☐ Evidence of Australian Citizenship
☐ Completed Centrelink Customer Consent form
☐ If applicable, evidence of your interstate address (i.e. drivers licence, high school report, official bill with your interstate address on it) ☐ A personal statement as outlined above (Question)
☐ Two written references
☐ Brief resume
25. Student Declaration
I declare that the information I have supplied within this application is true and correct to the best of my knowledge. I understand if any false or misleading information is provided it could lead to the cancellation of my scholarship. I also understand giving false or misleading information is a serious offence under the Criminal Code.
I consent to the disclosure of relevant information for the selection process of this scholarship
Date: Click here Signature of Applicant: Click here to enter text. to enter a date.