Wyndham
Richardson
Wyndham Richardson Scholarship Fund
APPLICATION FORM
Wyndham Richardson Scholarship Fund is offering a number of scholarships for students enrolled
on a full-time basis in a Certificate IV or above (AQF) qualification.
Scholarships are awarded to the value of $1000 provided you are enrolled and actively participating
in full-time study.
The Wyndham Richardson Scholarships are awarded to students who demonstrate a commitment
to study and are in significant financial hardship.
Scholarships are only available to Australian Citizens and Permanent Residents.
PERSONAL DETAILS
First Name: _______________________________
Surname: ___________________________________
Postal Address: _________________________________________________________________________
__________________________________________________________________ Postcode: ___________
Telephone: (
)__________________________ Mobile: ______________________________________
Email (primary means of communication): _____________________________________________________
Gender: Male 
Australian Citizen
Female 

OR
Date of Birth: (dd/mm/yyyy) __________________________________
Permanent Resident

OR
Non-Permanent


VISA sub-class:
___________
Year of arrival in Australia (If not Australian Citizen or Permanent Resident): __________________________
Full-time student: Yes 
No 
Certificate IV or above (AQF) qualification:
Yes 
No 
Title of Qualification: _____________________________________________________________________
Campus: ___________________________ TAFE SA Student ID number: __________________________
EDUCATIONAL BACKGROUND
List any previous completed qualifications in the table below. In the last column, please indicate whether your
past qualifications have been recognised in Australia – if completed overseas.
Qualification
e.g. Certificate IV,
Diploma, Bachelor
Degree
Subject Area
e.g. Chemical
Engineering, IT
Educational
Institution &
Campus
e.g. TAFESA, Port
Adelaide
Years of Study
e.g. 1998-2000
Recognised
Yes/No
COPY OF STUDY RESULTS
I have attached a copy of my most recent results (which have been translated into English if necessary) with
this application form.
 Yes
 No, I have not included results
 No, as this is my first semester of study
SECTION 4 – EMPLOYMENT BACKGROUND / WORK EXPERIENCE
List (most recent first) any jobs in which you have been/are employed.
Job Title
e.g. Account Manager
Main Tasks
e.g. Accounting
Employer, Country
e.g. EDS, Australia
Years of
Service
e.g. 12 years
4.
FINANCIAL DETAILS (PLEASE READ CAREFULLY & ANSWER ACCURATELY)
1. Are you independent as classified by Centrelink? Yes or No (please circle) If YES, complete the
LIVING INDEPENDENTLY* column for Q3 & Q4. If NO, Please answer Q2.
2. Are you living with your parents/guardian/partner? Yes or No (please circle) If YES, are
parents/guardian/partner providing financial assistance for your study?) If YES, please complete the
HOUSEHOLD column with your parents/guardian/partner income/expenditure for Q3 & Q4).If NO, please
detail all your expenses and income in the column (LIVING INDEPENDENTLY*)
3. INCOME on a FORTNIGHTLY basis:
(Please include evidence of a Centrelink financial statement or a copy of your bank statement and three recent pay slips)
INCOME (on a FORTNIGHTLY basis)
LIVING
HOUSEHOLD**
INDEPENDENTLY*
Total number of members: ____
Salary/Wage (before deductions)
$
$
Centrelink:
$
$
$
$
$
$
$
$
$
$
$
$
Child Maintenance received
Other Income (e.g. Austudy Supplement, Rent, Interest)
$
$
$
$
TOTAL INCOME per fortnight
$
$
Benefits***
Rent Relief
Family Payment
Parenting Allowance
minus
Tax deductions
Centrelink deductions
Relationship of
members to you:
(e.g. Partner,
Parent/Guardian, Child,
Sibling, Housemate etc.)
1:
2:
3:
4:
5:
6:
*** Including Youth Allowance, Austudy, Abstudy, Parenting Payment Single, Aged, Disability and Newstart.
EXPENSES on a FORTNIGHTLY basis:


Please list all ESSENTIAL expenses you will have during the period for which you are enrolling.
Only provide Household expenses here if you have HOUSEHOLD income as quoted in Q3.
LIVING
EXPENSES (on a FORTNIGHTLY basis)
HOUSEHOLD **
INDEPENDENTLY *
Mortgage, Rates & Taxes
Rent or Board (please circle)
$
$
$
$
Food, Groceries etc.
Gas &/or Electricity
Phone (including Mobile)
Water
$
$
$
$
$
$
$
$
Insurance (Health, Building, Contents, Car etc)
$
$
Maintenance/Allowances paid for/to Dependents
$
$
Car Maintenance & Petrol
Public Transport (Bus, Tram or Train Tickets)
$
$
$
$
Loan Repayments
$
$
Credit Card Repayments (Minimum required)
$
$
Other known ESSENTIAL expenses
$
$
TOTAL EXPENSES per fortnight
$
$
5. Total income (from 3) minus
Total expenses (from 4)
BALANCE per fortnight
$...............
$............... = $...............
I certify that to the best of my knowledge and belief that the details in this financial statement are true in every particular.
Student Name: _________________________
Student Signature: _________________________
COMMITMENT TO STUDY (200 WORD STATEMENT)
Please complete a 200 word statement describing your commitment to study in your chosen career
path and how this scholarship would assist. (If preferred, you can type your statement and attach it
to the application).
Student Name:
DECLARATION
I declare, I am not in receipt of any other scholarship support valued at $500 or more.
I agree to TAFE SA providing the Wyndham Richardson Scholarship Fund with my name, contact
details and course title, if I am successful in obtaining this scholarship.
Name:
Signature:
Date:
/
/
REMINDER: The following details must be included (photocopy/scan) for your application to be eligible:
1.
2.
3.
4.
5.
Proof of full-time study load (e.g. TAFE SA student ID card)
Proof of current enrolment in a Certificate IV (or above) qualification
Certified copies of qualifications or relevant experience if applicable (translated into English if necessary)
Proof of citizenship or permanent residency
Income statement/proof of income (e.g. Centrelink statement)
Please forward completed applications and all supporting documentation by COB Friday, 14 August 2015 to:
Mikaela Millar
Student Welfare and Career Officer
TAFE SA
Student Services
137 Days Road
Regency Park SA 50110
Tel:: 08 8348 4429
Email: mikaela.millar@tafesa.edu.au
Please attach all requested documentation to your application.
Incomplete applications will not be proceed to the selection process.