Edith Cowan University Student Services Centre - Scholarships Dr John Woolcott Scholarship Application Form All questions on the application form must be completed and ALL supporting documentation including written statement must be provided where indicated otherwise the application may not be considered. Please ensure that your correspondence address details are updated on SIMO Student ID: Mobile No: First Name: Surname: Student Email 1. Are you an Australian Citizen or an Australian Permanent Resident? Yes No – you are ineligible for this scholarship 2. In which ECU course are you currently enrolled? Bachelor of Health Science – All Majors Bachelor of Science (Nursing) Bachelor of Science (Nursing) and Bachelor of Science (Midwifery) - double degree Bachelor of Science (Paramedical Science) None of the above – Sorry you are ineligible for this scholarship 3. Have you completed at least 4 units (60credit points) in this course and your current course average is at least 70% 4. Have you previously completed a bachelor degree at ECU or another university? 5. Are you currently receiving any educational subsidy from your employer? If yes - Please specify: 6. Are you currently receiving any other scholarship or similar award? If yes - Please specify 7. Are you currently receiving an allowance payment from Centrelink such as Youth Allowance, Austudy, and Abstudy etc.? 8. If you are not in receipt of a Centrelink allowance as per Q7, please provide the figure for the Gross Annual household Income. Please note that the figure you provide must include the income of all members of your household who are eligible to complete a tax return i.e. partners and parents. Yes No – you are ineligible for this scholarship Yes – Sorry you are ineligible for this scholarship No Yes No Yes No No – go to Q8 Yes - Complete a Centrelink Consent Form Breakdown and total Gross Annual Income for your household Yours: $ Partner: $ Parents: $ Other: $ Total : $ Scholarships Telephone: +61 8 6304 3636 Fax: +61 8 6304 2088 Email: scholarships@ecu.edu.au Edith Cowan University Student Services Centre - Scholarships 9. Have you previously been awarded the Dr John Woolcott Scholarship? Yes - you are ineligible for this scholarship No 10. Written Statement Please attach a written statement (approx. 1 x A4 page) outlining: Your personal circumstances, indicating any current financial disadvantage. 11. Checklist – Please tick to indicate that you have attached the following supporting documentation (where applicable) to this application form. Failure to provide supporting documentation may affect you receiving a scholarship offer. a. Evidence of Australian Citizenship or permanent resident status (i.e. birth certificate / passport/visa or citizenship certificate) (Q1) b. Completed Centrelink Customer Consent form (Question 7 ) c. Copies of most recent tax returns from all relevant household members(Q8) d. A copy of your last semester results e. A written statement as outlined above. (Question 10) All information provided in this application will be treated as confidential Declaration I declare that the information I have supplied on this form and in associated attachments is complete, true and correct, to the best of my knowledge. I understand that if any information is found to be incorrect, my application may be cancelled. Signature of Applicant Date Completed application forms & associated documentation should be forwarded to: Scholarships Office Edith Cowan University 270 Joondalup Drive Joondalup WA 6027 Ph: (08) 6304 3636 Fax: (08) 6304 2088 Email : scholarships@ecu.edu.au Scholarships Telephone: +61 8 6304 3636 Fax: +61 8 6304 2088 Email: scholarships@ecu.edu.au