2016 APPLICATION FORM
The Australian Psychological Society bursary
of Financial Assistance for People of Aboriginal
and Torres Strait Islander Descent:
The Bendi Lango bursary
The closing date for applications is Friday 1 April 2016.
Please attach:
A letter confirming your Aboriginal and/or Torres Strait Islander heritage
Documents demonstrating your financial position
Copy of academic transcript and proof of acceptance/enrolment into postgraduate degree
Completed Community Referee Report
Completed Academic Referee Report
To:


Email: science@psychology.org.au
Post: The Administrator, Science and Education
The Australian Psychological Society Ltd
PO Box 38
Flinders Lane VIC 8009
Enquiries:


Email: science@psychology.org.au
Phone: (03) 8662 3300
Updated: 17 November 2015
1. Information about the applicant
Title:
......
Address:
First Name:
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Family Name:
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Telephone:
.................................................
Email:
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APS membership grade
(if applicable):
...........................
Mobile:
Membership
number:
..................................
..................................
2. Confirmation of Aboriginality
Please attach a letter of Aboriginal and/or Torres Strait Islander heritage by an
Indigenous organisation who has a common seal of certification. (Other proof of
heritage may be considered at the discretion of the Selection Committee)
Name of
organisation:
Address:
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..........................................................................................................
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Telephone:
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Email:
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3. Personal statement
Please complete the three sections below:
Q1: Please comment on the contribution you have made to your community and the
broader community to date (max. 300 words)
Q2: What are your planned future contributions to your community and the broader
community? (max. 300 words)
Q3: What would the receipt of financial assistance from the APS mean to you?
(approx. 100-150 words)
4. Financial statement
In acknowledgement of the hardship faced by many people of Australian Aboriginal and Torres
Strait Islander descent, the APS has established the Bendi Lango bursary for the purpose of
offering funding to alleviate some of these financial concerns. Donations to the APS fund set up
for this bursary are tax deductible. Therefore, the Australian Taxation Office requires us to ask
you for some evidence of your 'necessitous financial circumstances'. These are defined as
'circumstances where an applicant’s financial resources are insufficient to obtain all that is
necessary for a modest standard of living, which is a standard of living greater than bare
existence'.
Please attach a statement of your financial position
Please include any or all of:
(i)
A statement of your monthly income and outgoings
(ii)
A copy of your most recent tax return
(iii)
The basis on which you have been assessed as qualifying for social welfare, if
applicable (e.g. Healthcare card, Abstudy/Austudy, Centrelink benefit)
(iv)
Any other circumstances which may be causing you financial hardship.
5. Education details
Please attach a copy of your academic transcript(s) to date, as well as proof of offer
and acceptance, or enrolment, in an APAC-accredited postgraduate psychology
coursework degree
Undergraduate course details:
.....................................................................................................................................
Years of study:
...................................................
Details of proposed/current postgraduate course:
.....................................................................................................................................
6. Community referee
Please attach the completed Community Referee Report Form (Attachment A)
(The Selection Committee recommends that the report come from an individual or organisation
familiar with your community contributions)
Name of community referee:
........................................................................................
Contact number:
........................................................................................
Email:
........................................................................................
7. Academic referee
(For example: Academic supervisor / Director or Staff of Indigenous Centre)
Please attach the completed Academic Referee Report Form (Attachment B)
Name of academic referee:
........................................................................................
Contact number:
........................................................................................
Email:
........................................................................................
Signature of Candidate:
Print name:
Date:
The closing date for applications is Friday 1 April 2016.
The completed application form with required attachments should be emailed to:
science@psychology.org.au.
Alternatively, all documentation can be sent to:
The Administrator, Science and Education
Australian Psychological Society
PO Box 38
FLINDERS LANE VIC 8009
Attachment A – Community Referee Report
As part of the application for the Bendi Lango bursary, Candidates must provide a reference,
preferably from an Aboriginal or Torres Strait Islander community controlled organisation.
This reference will be treated as confidential. Please complete this form and return it directly to
the Candidate to attach to their Bendi Lango Application form.
If you have any queries about completing this form, please contact Nicole Feast, Science and
Education Coordinator, at science@psychology.org.au or on (03) 8662 3362.
Candidate Details (Candidate to complete)
Title
Surname
Given Names
Course of Study and University
Mr / Mrs / Miss / Ms
Community Referee Details (Referee to complete)
Title
Surname
Given Names
Name of Organisation
Position within Organisation
Address of Organisation
Mr / Mrs / Miss / Ms / Dr / Professor
Contact Number
Email Address
Community Reference (Referee to complete)
Does the Candidate actively identify as an
Aboriginal or Torres Strait Islander person?
Yes / No
Does the community in which he or she
lives accept the applicant as an Aboriginal
or Torres Strait Islander person?
Yes / No
In what capacity do you know the
Candidate?
For how long have you known the
Candidate?
Q1: In what ways has the Candidate demonstrated involvement and commitment to the
Indigenous community?
Q2: In what ways do you believe the Candidate will contribute to his or her community
in the future?
Q3: What are the outstanding qualities of the Candidate, and how might they contribute
to his or her future career in the field of psychology?
Q4: Why do you believe that the Candidate should be awarded the Bendi Lango bursary?
General comments:
Please attach additional pages if more space is required
Signature of referee:
Print name:
Date:
Upon completion of this report, please return it to the Candidate.
Attachment B – Academic Referee Report
As part of the application for the Bendi Lango bursary, Candidates must provide an academic
reference.
This reference will be treated as confidential. Please complete this form and return it directly to
the Candidate to attach to their Bendi Lango Application form.
If you have any queries about completing this form, please contact Nicole Feast, Science and
Education Coordinator, at science@psychology.org.au or on (03) 8662 3362.
Candidate Details (Candidate to complete)
Title
Surname
Given Names
Course of Study and University
Mr / Mrs / Miss / Ms
Academic Referee Details (Referee to complete)
Title
Surname
Given Names
Name of Institution
Position within Institution
Address of Institution
Mr / Mrs / Miss / Ms / Dr / Professor
Contact Number
Email Address
Academic Reference (Referee to complete)
Q1: For how long have you known the Candidate, and in what capacity?
Q2: What was the topic of the Candidate’s Honours thesis (if known)?
Q3: How would you describe the past academic results and academic potential of the
Candidate?
Q4: What personal attributes does the Candidate possess that might contribute to his or
her future career in the field of psychology?
Q5: Why do you believe that the Candidate should be awarded the Bendi Lango bursary?
General comments:
Please attach additional pages if more space is required
Signature of referee:
Print name:
Date:
Upon completion of this report, please return it to the Candidate.