Postgraduate Study Support
Scheme: Application Form for
Course Approval
TO BE COMPLETED BY APPLICANT
I hereby apply for a 25% rebate of the fees for a full fee-paying, postgraduate course or Associate
Student Program subject(s) at Charles Sturt University. I understand that I am bound by the current
Academic Regulations of Charles Sturt University.
Staff member’s details
1.
Applicant’s name:
2.
Position:
3.
4.
Division/Section or
Faculty/School:
CSU campus or site:
5.
Contact telephone number:
6.
E-mail address:
7.
Staff number:
Eligibility
8.
Are you eligible to apply for
the Postgraduate Study
Support Scheme?
Yes
No
If “no”, please do not proceed – your
application is unable to be considered.
(Refer to clause 4 of the policy.)
Course / Associate Student Program details
9.
Name of postgraduate
course or Associate Student
Program subject(s):
Associate Students – please go to Question 12.
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
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10.
11.
Total number of subjects to
be completed in the course
(excluding credits):
Does your course involve
writing a thesis?
Yes
No
If “yes”, what is the thesis topic?
12.
13.
Course / Associate Program
commencement date
(month & year):
Expected course /
Associate Program
completion date (month &
year):
Session details
14.
15.
16.
17.
Number of subjects (or
thesis) in the coming
academic session:
Total course fees for the $
session:
subjects
thesis
Start date of session:
End date of session:
Benefits
18.
How are the subject(s) in which you are enrolled for the academic session
relevant to your current position?
19.
How will the subject(s) in which you are enrolled for the academic session
enhance your performance/capability for your current position?
20.
How will the subject(s) in which you are enrolled for the academic session
enhance the capability of your Section/School, Division/Faculty or University?
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
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Report
21.
I agree to report on my academic progress and professional development
outcomes at performance management meetings.
Yes
No
If “no”, then this application is unable to be considered.
Applicant’s signature:
Date:
TO BE COMPLETED BY SUPERVISOR*
*NOTE: If the direct supervisor is employed at HEW level 6 or below, this section should be
completed by the manager.
22.
Has this postgraduate course or Associate Student Program subject(s) been
negotiated as part of the applicant’s professional development plan in the
Performance Management Scheme?
Yes
No
NOTE: If recommending this postgraduate study for approval of financial assistance,
but “no” has been ticked, then please add the course or Associate Student Program
subject(s) to the applicant’s professional development plan for the purposes of:
(a) providing the support and resources needed; and
(b) monitoring progress and professional development outcomes.
23.
I support / do not support this application. Please outline your reasons.
24.
Who will be responsible for paying the 75% balance of the course fees?
Staff member
Signature:
Faculty/Division/Office
Date:
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
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TO BE COMPLETED BY EXECUTIVE DIRECTOR / DEAN / PRIMARY BUDGET
CENTRE MANAGER
25. This application for financial support of postgraduate study is approved / not
approved. Please outline your reasons.
Signature:
Date:
Endorsement: Manager, Learning and Development, Division of Human
Resources:
Signature:
Date:
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
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Postgraduate Study Support Scheme
Applicant’s Checklist
Refer to relevant information in the Policy and Procedure on the Postgraduate
Study Support Scheme.
Complete the “Application for Approval Form” (PG1).
Complete the “Residual Benefit Declaration”.
Photocopy your offer of admission.
Discuss your application and submit (a) the completed “Application for
Approval Form”, (b) “Residual Benefit Declaration” and (c) a copy of your offer
of admission to your supervisor for recommendation for approval.
The supervisor forwards the recommended application (as well as the
admission offer and the original residual benefit declaration) to the Executive
Director / Dean / primary budget centre manager for approval.
The Executive Director / Dean / primary budget centre manager stores the
original application (with recommendation and approval comments) and a
copy of the admission offer on file.
The Executive Director / Dean / primary budget centre manager forwards a
copy of the approved application and admission offer to the staff member and
the staff member’s supervisor.
The Executive Director / Dean / primary budget centre manager forwards a
copy of the approved application and admission offer, as well as the original
residual benefit declaration, to the Career Programs Officer, Division of
Human Resources, Wagga Wagga.
Privacy Statement
The personal information you provide on this form is protected by the Privacy and Personal Information Protection
Act 1998 (NSW).
Provision of this information is a requirement of participation in CSU’s Postgraduate Study Support Scheme for
General Staff.
Access to the information you provide is available to yourself, your supervisor, the Executive Director / Dean / primary
budget centre manager, and those persons authorised to access the information in the course of their duties to CSU.
This document will be stored in the Organisational and People Capability Directorate, Division of Human Resources.
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
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Residual Benefit Declaration
DECLARATION BY APPLICANT
I, ____________________________________ , declare that the cost or part-cost of
tuition was provided to me by or on behalf of my employer during the period:
Start date: _________________________ End date: ________________________
and that the benefit was used by me for the following purpose:
self-education which is required to earn a taxable income.
I also declare that, had I purchased the service or privilege, etc for its market value, I
would have been entitled to claim an income tax deduction equal to 100% of the
purchase price.
I understand that this declaration is to apply to the above stated benefit and to any
identical benefit* for a period up to 5 years from the date of this declaration or until
the stated percentage incurred in earning my assessable income decreases by more
than 10 percentage points. This declaration will also be revoked if another recurring
residual benefit declaration is provided in respect of a subsequent identical benefit.
Signature:_______________________________ Date: _______________________
*Identical benefits are ones which are the same in all respects except for any
differences that are minimal or insignificant, or that relate to the value of the benefits,
or that relate to a change in the deductible proportion of 10 percentage points or less.
Submit the completed form to:
Career Programs Officer,
Division of Human Resources, Wagga Wagga.
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
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Staff Development – Fee Support
If you wish to repay your CSU loan instalments by direct debit from
your salary, please sign and complete and this form.
To:
Accounts Receivable
Division of Financial Services
WAGGA WAGGA
Name:
(Please Print)
CSU Salary Number:
I authorise Charles Sturt University to deduct the sum of
$__________ per fortnight from my salary, for _________
commencing on
/
/
* fortnights,
until my debt of $__________ is repaid
in full.
Signature:
__________________________________________
Date:
/
Tertiary Institution:
__________________________________________
*
/
When calculating the number of fortnights, the final dates for payment will be the
last day of the relative session or trimester to which the fees relate.
NOTES:
1.
2.
3.
In the event of termination of employment with Charles Sturt University, the
amount outstanding will be deducted from your termination pay.
In the event of termination of study, any refund should be applied to any
outstanding debt with Charles Sturt University.
If you are studying at an institution other than Charles Sturt University, a cheque
will be drawn in favour of that institution and sent to you. It will be your
responsibility to forward the cheque and any associated paperwork to that
institution for processing.
To commence this process, please return this form to Accounts Receivable in
Wagga Wagga, along with a copy of your liability statement.
Postgraduate Study Support Scheme: Application for Renewal of Financial Support (PG2)
Version – October 2011
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