South Australian Medical Women’s Society Scholarships 2015
These Scholarships have been established to commemorate The South Australian Medical
Women’s Society (1927-2006).
These Scholarships are open to female students who are Australian citizens or permanent
residents of Australia and undertaking a clinical elective in either a developing country or in an
indigenous community within Australia, as part of their Bachelor of Medicine, Bachelor of Surgery
program of study at the University of Adelaide. Preference will be given to students in the 5th and
6th years. Two scholarships valued at $1000 each are available in 2015.
Applicants must be able to demonstrate academic merit and financial need and be able to provide
supporting documentary evidence at the time of application, eg details of income tested
Commonwealth income support payment, such as Youth Allowance, Austudy, ABSTUDY benefits,
or other details of their financial circumstances.
The scholarship will provide assistance with travel/accommodation and other educational costs
associated with the clinical placement.
Selection for these scholarships will be made according to academic merit and financial need.
The Scholarship must be taken up in the year in which it is offered; acceptance of the Scholarship
offer cannot be deferred. If a student declines the Scholarship offer, the Scholarship will be
offered to the next eligible student.
Applications for this scholarship close Friday 27 November 2015.
SOUTH AUSTRALIAN MEDICAL WOMEN’S SOCIETY
SCHOLARSHIPS 2015
APPLICATION FORM
These scholarships are available to female students who are Australian citizens or permanent residents of Australia and undertaking a
clinical elective in either a developing country or in an indigenous community within Australia, as part of their Bachelor of Medicine,
Bachelor of Surgery program at the University of Adelaide.
Please read the attached flyer to ensure you are eligible to apply before completing the application.
Scholarship applications close Friday 27 November 2015.
Personal Details
Title:
Family Name:
Given Names:
Permanent Home Address:
State:
Post Code:
State:
Post Code:
Home Phone Number:
Semester Postal Address:
Semester Phone Number:
Mobile Number:
Email Address:
University of Adelaide Student Number:
Are you:
An Australian citizen
The holder of a permanent humanitarian visa
An Australian Permanent Resident
Other (please specify details, e.g. New Zealand Citizen) ……………………………………………………
What is your date of birth? ……………./…………/……….. Gender :
M
F
University Study Details
Which undergraduate program of study will you be
undertaking in 2015? (e.g. Bachelor of
Medicine/Bachelor of Surgery)
Which year of study in the MBBS will you be
undertaking in 2015? (e.g. Year 5)
Yes – Developing Country
Yes – Indigenous Community
Are you going to be undertaking a clinical elective in
late 2015 or early 2016 in either a developing country
or in an indigenous community within Australia?
Please state where your clinical elective placement is
to be conducted?
How did you find out about this scholarship?
………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………
Have you applied for any other University scholarships?
Yes /
No
If yes, please provide details of scholarships applied for:……………………………………………………………
……………………………………………………………………………………………………………………………………
Do you hold any other scholarship/s currently?
If yes, please provide details:
Name of Scholarship:
Organisation providing Scholarship:
Annual payment:
Date scholarship commenced:
/
Yes /
/
No
Date scholarship will end:
/
/
Financial Situation
1) Are you currently in receipt of a means
tested Centrelink income support
payment? (e.g. Austudy, ABSTUDY, Youth
Allowance, etc)
Yes
No
– please go to question 2
If yes, please advise the type of payment and then go to question 3
Type of payment:
Documentary evidence MUST be supplied (e.g. current Centrelink statements
showing entitlements and rate of pay)
2) Have you applied for a Centrelink
benefit but it has not yet been approved?
Yes
No
– please go to question 3
If yes, please advise the type of payment and then go to question 3
Type of payment:
Documentary evidence MUST be supplied as soon as your benefit is
approved (e.g. current Centrelink statement showing entitlements and rate of pay or
letter from Centrelink advising you of approval)
3) All applicants - please complete the questions and table below with your financial information to allow us to make an
assessment of your level of financial need.
Money or assets in reserve (bank accounts/shares etc)
$...........................................
Income amount per week:
. Living Expenses – Amount per week:
Rent/Board:
$...........................................
Electricity/Gas:
$...........................................
Telephone:
$...........................................
Parent/Spouse support: $..................................
Food:
$...........................................
Own earnings (per week): $...............................
Transport:
$...........................................
Other:
$...........................................
(e.g. Child Support payments, income from Trusts,
companies or partnerships in which you have an
interest)
Entertainment:
$...........................................
Centrelink Benefit: $...........................................
Scholarship:
$...........................................
Other (clothes,etc) $...........................................
Loan repayments: $...........................................
Credit Card:
Total: $...........................................
4) All applicants – How would you spend the money if
you were granted this scholarship?
$...........................................
Total: $...........................................
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5) All applicants - Please provide a statement outlining the circumstances that you consider demonstrate that you are in
financial need. This can include issues such as the distance you live from campus, your living arrangements, how many
income earners and dependants there are in your family, whether you and/or your family rent or own your home, whether you
or any of your family members have illnesses or disabilities, whether you have any significant debts and any other issues
relevant to your personally. (You may attach a separate sheet if you need more space)
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Declaration
I declare that the information I have supplied on this form is true and correct to the best of my knowledge.
I understand that if I am awarded the scholarship and the University of Adelaide at any time thereafter forms the reasonable
view that my application included false or misleading information or documentation, the scholarship may be cancelled by the
University of Adelaide and any funds I have been paid must be refunded.
I authorise the University of Adelaide to obtain such additional information deemed necessary to assess my application for this
scholarship.
I understand that the University of Adelaide will not disclose any information supplied on the application form or obtained for
the selection process without written consent of the applicant. The information supplied will only be used for the selection
process of this scholarship program and will be managed in accordance with the University of Adelaide Privacy Policy and
Management Plan available at http://www.adelaide.edu.au/policies/62
I understand that if I am awarded and accept the scholarship, I will be obliged to comply with the terms and conditions of the
scholarship.
Applicant signature:
Date:
If you have any questions about your application, please contact the Scholarships Office on (08) 8313 4224 or (08) 8313 6959, or email:
undergraduatescholarships@adelaide.edu.au
Please forward the completed application form to:
Coursework Scholarships Office C/- Ask Adelaide, Hub Central, Level 3 Blue Area, The University of Adelaide, SA 5005
Closing date: Friday 27 November 2015
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