ANNUAL APPEAL EMERGENCY BURSARY
Background
In response to the Tasmanian bushfires early in 2013 the UTAS Foundation made a call for
donations to UTAS alumni and friends through the Annual Appeal. The resulting funds will be
made available to students who have been impacted by the bushfire events and require financial
assistance to commence or continue their studies in 2013.
Eligibility
The Annual Appeal Emergency Bursary is intended for any student who has been adversely
impacted by the bushfire events in Tasmania in 2013.
Requirements to be eligible for a bursary are:
 you have been financially impacted by the bushfire events in Tasmania in 2013 and able to
provide a statutory declaration (signed by a Justice of the Peace or Commissioner of
Declarations) describing how the bushfires have affected you and/or your family’s financial
circumstances
 you are a current or commencing student studying full-time in any undergraduate or
postgraduate course at UTAS
 you have enrolled, or will enrol prior to the payment of the bursary, at UTAS in Semester One
2013
Consideration may be made for students who are enrolled part-time if bursary funding permits.
Conditions of Award
1. The Bursary will be awarded on the basis of the impact of the bushfires on a student’s
ability to study in Semester One 2013, and consideration will take into account financial
need.
2. The amount of the Bursary will be a minimum of $500 and, subject to the number of eligible
applications received, be paid in one instalment in Semester One 2013.
3. The bursary will not impact on any other scholarship or award held by a student. Students
are advised to check with Centrelink regarding any impact it may have on payments.
Completing the application form
Please complete the application form, including the statutory declaration, and return the
application form with all documentary evidence by 5.00pm on Friday 8 March
Visit www.justice.tas.gov.au/justice/commissionersfordeclarations for details of who can witness
the Statutory Declaration.
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2013 Annual Appeal Emergency Bursary application form
All information will be held in strict confidence and viewed only by relevant University staff. UTAS
is bound by the Personal Information Protection Act 2004 (Tas). Full details of the UTAS Privacy
Policy can be found at www.utas.edu.au/privacy/
Send completed application form by 5pm Friday 8 March via;
Email:
University.Foundation@utas.edu.au
Subject – “ANNUAL APPEAL EMERGENCY BURSARY”
Any questions relating to the Bursary and eligibility may also be directed to this
email.
In person:
(In a sealed envelope marked ANNUAL APPEAL EMERGENCY BURSARY)
UTAS Foundation
Building 18
Upper Level University Club
Cnr Churchill Ave & Alexander Sts
Sandy Bay Campus
By mail:
UTAS Foundation
Private Bag 40
Hobart TAS 7001
If you wish to discuss your University enrolment, study load or current scholarships,
contact:
Inquiries:
Student Centre
Student.Centre@utas.edu.au
1300 361 928
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2013 Annual Appeal Emergency Bursary application form
1.1. Personal details
Title (Mr, Ms etc)
UTAS student
number
Family name
Given name(s)
Date of Birth
Semester address:
Address:
Postcode:
Phone:
Permanent home address:
Address:
(if different from above)
Postcode:
Phone:
Mobile telephone
number
Email
1.2. Academic details
Current UTAS course
details
Name of Course (eg: Bachelor of Arts)
Course Code (if known):
[tick boxes by double-clicking on box and selecting ‘checked’]
Status
Full-time student
Part-time student
(Please note: part-time students will be considered if funding permits)
Campus
Commencing or current
student at UTAS
Commencing study in 2013
Undergraduate or
Postgraduate
Undergraduate
Continuing study in 2013
Postgraduate
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2013 Annual Appeal Emergency Bursary application form
1.4. Financial hardship
You must complete the
statutory declaration on
page 4 of this application
This information is to
provide additional
information in relation to
your financial situation
Centrelink (Youth Allowance) entitlement and rate of payment: $
Other Centrelink payments Type:
(Please indicate payment type and fortnightly amount): $
Other evidence of low income (provide a statement of your financial situation
prior to the bushfires to support your application) for example, parents
employment status, number of siblings being supported, moving away or
living away from home to study, travel costs, whether you are supporting
yourself.
(Please specify):
Are you personally in receipt of any other income (eg p/t work, family support):
Yes
No
If yes, please specify and provide approximate income per fortnight:
Note: Unsigned applications or those without supporting documentation will not be considered. The attached
Statutory Declaration must be completed and submitted with this application to be eligible for the UTAS
Foundation Emergency Bursary.
Visit www.justice.tas.gov.au/justice/commissionersfordeclarations for details and a list of who can witness
your statutory declaration.
Students will be notified via email as soon as practicable after 4 March.
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2013 Annual Appeal Emergency Bursary application form
Statutory Declaration
I,
<full name>
of
<address>, <occupation>
do solemnly and sincerely declare that:
<describe the impact of the bushfire events in Tasmania in 2013 has impacted you and/or your
family’s financial circumstances>
I make this solemn declaration under the Oaths Act 2001.
Declared at (place)
on (date)
Signature
before me (Justice, commissioner for declarations or authorised person)
Name
Position
Signature
Date
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