Apply for a scholarship.

Title: –None– Mr Mrs Ms Dr Prof

First Name:

Last Name:

Street Address:

Suburb:

State: –None– NSW VIC QLD TAS SA WA ACT NT

Postcode:

Email

Phone

Date of Birth:

How do you identify?: –None– Bisexual Gay Heterosexual Lesbian Other Prefer not to say Queer Transgender

Resident/Citizenship Status: –None– Australian Citizen Permanent Resident

Name of selected course:

Name of Institution:

Anticipated length of course (full-time equivalent):

Study Mode: –None– Full-time Part-time

Have you undertaken any previous study after leaving school?: –None– Yes No

If yes, please outline:

Please explain how completing the selected course will change your life and/or benefit your career:

Please tell us want benefits, directly or indirectly, you anticipate to the LGBTIQ community or the community at large, from you completing this course of study:

If you have been affected by COVID-19, please outline how the pandemic has affected your current personal circumstances or your current studies and how this scholarship will assist you to commence or continue your studies:

Please outline any further supporting information that you think the Scholarship Selection Committee should be made aware of in relation to your application (if there is insufficient space you can upload in an attachment):

After submitting this form you will be sent an acknowledgement email requesting evidence to support it.

Please respond to the email and attach the following (please provide electronic copies only):
• Proof of Australian citizenship or permanent residency
• Proof of address
• Prior tertiary education transcripts (if any)
• Letters from two referees which address the selection criteria outlined above
• Current curriculum vitae