Student Name: _____________________________________________________________
CURTIN UNIVERSITY CANNING COLLEGE INTERNATIONAL BURSARIES
2016
APPLICATIONS CLOSE 4PM 11th MARCH 2016
DO NOT BIND OR STAPLE ANY OF YOUR PAGES TOGETHER
Future students are students who are commencing in Semester 1, 2016.
Please write using BLOCK LETTERS
Curtin Student ID (if known): ________________________________________________________________________________________
Family Name:
__________________________________________________________________________________________________
First Name:
__________________________________________________________________________________________________
Date of Birth:
_______________________________________
Phone Number: __________________________________________
Email Address: __________________________________________________________________________________________________
All correspondence in relation to your application will be sent to:
•
•
Your student email address if you have received an offer of admission or enrolled in your course, OR
The email address which you have supplied on this application form (if you have not yet received an offer of admission nor enrolled).
SECTION A
Personal Details
SECTION B
Merit
SECTION C
Documentation Requirements Checklist
DECLARATION & CONSENT
ALL applicants to complete
Please visit the scholarships website to see the full criteria for each scholarship: scholarships@curtin.edu.au
Please follow the application guidelines on the scholarships website for all application requirements and FAQs
Please tick where applicable 
Tick the scholarship
you wish to apply
for
SCHOLARSHIPS

I have read and
meet the criteria
for this scholarship

Curtin Canning College Engineering International Scholarship
Curtin Canning College Science International Scholarship
OFFICE USE ONLY
RECEIPT METHOD
DOCUMENTS CHECKED
POST |
FAX
Y
|
|
IN PERSON
N
SCANNED
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CRICOS Provider Code WA 00301J
Student Name: _____________________________________________________________
SECTION A – Personal Details
1
Are you an international student?


2
4
No  You are not eligible to apply for the scholarships on this form – do not continue
Do you hold a valid Student Visa – Higher Education (Subclass 573)?



3
Yes
Yes  Attach document A – Refer documentation checklist
Currently applying
 Attach document B – Refer documentation checklist
No  You are not eligible to apply for the scholarships on this form – do not continue
Did you attend Canning College in 2015?


Yes  Attach document C – Refer documentation checklist
No  You are not eligible to apply for the scholarships on this form – do not continue
What will your semester address be?
POSTCODE:
5
Have you applied for 2016 entry to study at Curtin University?


6
Yes
No  You are not eligible to apply for the scholarships on this form – do not continue
Please supply details of the course you have applied for below:
Course Name: _________________________________________________________________________________________
Course Code: __________________________________________________________________________________________
Intended Major: ________________________________________________________________________________________
7
Have you applied for or been awarded any other scholarships, cadetships or cash prizes?


No
Yes  Please complete below


Currently applying for other scholarships (other than on this form)  Complete 7a
7a
Please supply details of other scholarships that you are currently applying for (other than the scholarships applied
for in this form)
Currently in receipt of other scholarships  Complete 7b
NAME OF SCHOLARSHIP
1
2
7b
Please supply details and value of other scholarships that you are currently in receipt of, or have been awarded
NAME OF SCHOLARSHIP
AMOUNT PER SEMESTER
START YEAR
END YEAR
1
2
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CRICOS Provider Code WA 00301J
Student Name: _____________________________________________________________
SECTION B – Merit
Please attach a list of all your achievements to date using dot points under each heading below
8
a)
b)
c)
9
Academic achievements
Leadership achievements
Extracurricular achievements including any community, sporting or cultural achievements
 Attach Document D – Refer documentation checklist
Please attach a Selection Criteria Statement outlining the points below
a)
b)
c)
d)
Reasons for choosing to study your course
Your personal aspirations present and future
Any experience you have had within your chosen field
What qualities/attributes do you have, that will help you succeed in your chosen field
 Attach Document E – Refer documentation checklist
Follow the application guidelines available from the scholarships website for the required format and some examples on
reference requirements
SECTION C – Documentation Requirements Checklist
All documentation must be clearly labelled with
-
Your full name
Your student number (if known)
All applicants must submit


Document A:
Proof of student/visa
Document B:
Proof of visa application


Document C:
Results from Canning College
Document D:
Achievements List – List outlining achievements to date

Document E:
Selection Criteria Statement – Statement addressing criteria as outlined in question 9
If you have any questions about the documentation requirements, please contact the Scholarships Office by email
scholarships@curtin.edu.au or phone (08) 9266 2992
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CRICOS Provider Code WA 00301J
Student Name: _____________________________________________________________
DECLARATION AND CONSENT
I declare the information supplied by me to Curtin University of Technology (“Curtin”) is complete and correct in every particular.
1.
I understand the scholarship may be cancelled if it is proven that I was offered a scholarship based on false or misleading
information or documentation.
2.
I authorise Curtin to obtain from other educational institutions and relevant authorities, at any time, details of my enrolment and
academic record.
3.
I consent to Curtin using my personal information supplied for the following purposes:
4.
(a)
for Curtin Scholarships Office staff and selection committee members (which includes representative(s) of the
external sponsor, if any, and Curtin staff) to make the scholarship selection;
(b)
for the administration of the scholarship;
(c)
for Curtin’s general administrative purposes which includes communications involving surveys, the availability of
courses, alumni activity, newsletters and related marketing or promotional activity, and soliciting donations.
I acknowledge that I have read and understood Curtin’s Privacy Statement located at http://rim.curtin.edu.au/privacy/. I
understand this Privacy Statement describes how Curtin handles personal information in its possession or control.
Applicant Signature: ________________________________________________
Parent/ Guardian Signature (if under 18)
Date: ________________________________
HOW TO SUBMIT
Submit your completed application via one of the following options:
1.
In person:
Scholarships Office
Building 101, Level 1
Curtin University
Kent Street
BENTLEY WA 6102
3.
Post:
Curtin University
Scholarships Office
GPO Box U1987
PERTH WA 6845
3.
Fax:
Fax Number: 08 9266 3279
Please attach a front cover page containing
1. Student Name
2. TISC ID
3. Number of pages faxed
Please note: Emailed applications are not accepted
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CRICOS Provider Code WA 00301J
Student Name: _____________________________________________________________
Scholarship Feedback Survey
We value our students and appreciate any feedback that may enhance our services.
1.
How did you hear about the Curtin University scholarships you have applied for?








2.
High School
Newspaper/TV advertising
Parents/Family
Friends
Curtin Scholarships Website
Open Day
Promotional Event
Scholarships Alert
Your suggestions and comments would be very much appreciated
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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CRICOS Provider Code WA 00301J