Student Services Centre - Scholarships
Scholarships Telephone: +61 8 6304 3636 Fax: +61 8 6304 2088 Email: scho[email protected].au
Edith Cowan University
Inspiring Minds Equity Scholarships
Application Form
Important information
Applicants are strongly advised to read the Inspiring Minds Equity Scholarship – Applicant information
document, prior to completing and submitting their application.
All sections on the application form must be completed and it is the responsibility of the applicant to
provide relevant supporting documentation at the time of submission or the application may not be
considered.
Applicant Details
First Name
Surname
Student ID
Student email
Please ensure that your correspondence address details are updated on SIMO
You must be able to answer ‘Yes’ to questions 1 - 3
in order to meet the eligibility criteria for this scholarship.
1. Are you currently enrolled or intending to enrol in a full time
load (60 credit points) for semester 2, 2016?
Yes I am enrolled
Yes, I am intending to enrol
2. Have you completed a minimum of 60 credit points in your
current course? (excluding any Advanced Standing)
Yes
3. Have you achieved consistent pass grades?
Yes
Financial and Personal Circumstances
4. Please confirm that you are one of the following : -
Australian Citizen Australian Permanent Resident New Zealand Citizen
5. Are you from a rural, regional or remote area of Australia?
Yes No
6. Did you relocate from a rural, regional or remote area of Australia in
order to study?
Yes No
7. Please provide Suburb and postcode of rural, regional or remote address
Suburb Postcode
8. How long did you reside in a rural, regional or remote address?
From (year ) to (year)
9. Are you of Australian Aboriginal and/or Torres Strait Islander
descent?
Yes No
10. Do you or someone you care for have a disability or ongoing illness
that significantly effects your ability to study?
Yes No
11. Are you registered with the ECU Equity Diversity and Disability Office?
Yes No
12. Are you personally in receipt of a means tested allowance from
Centrelink or the Department of Veterans Affairs?
Yes No
13. If you are a Centrelink Customer please ensure you complete the Centrelink Consent form -
(page 4 of the application form) providing your Centrelink Customer reference number
If you are a recipient of a Department of Veterans Affairs allowance then please provide evidence
of this.
Student Services Centre - Scholarships
Scholarships Telephone: +61 8 6304 3636 Fax: +61 8 6304 2088 Email: scho[email protected].au
Edith Cowan University
14. If you are not in receipt of a Centrelink allowance please outline any reasons why you may be
financially disadvantaged and why Centrelink does not recognise your circumstances?
15. Please confirm what is your monthly combined household income?
$ _______________ per month
Please note that a combined figure requires you to provide a total of monies received by all members of
your household, i.e. parents, partners, all adults in home.
16. Are you the holder of a valid current Health Care Card?
Yes No
17. Are you currently in receipt of any other scholarships or awards?
Yes No
18. Have you previously received the Inspiring Minds Equity scholarship?
Yes No
19. Please identify your living situation during 2016.
Single (living with parents/guardians/family members)
Single (living away from home/financially supported by parent/guardian
Single(living away from home/financially independent
Single with dependants
Partnered with no dependants
Partnered with dependants
Other (please describe in space below)
20. Please provide information relating to your circumstances, either past or present which have
had a significant impact on your life and capacity to give time and attention to your studies.
Student Services Centre - Scholarships
Scholarships Telephone: +61 8 6304 3636 Fax: +61 8 6304 2088 Email: scho[email protected].au
Edith Cowan University
21. Please provide a statement outlining your personal goals or what you hope to achieve upon
completion of your studies and how this scholarship will help you achieve these goals.
22. Checklist – Please tick to indicate that you have attached the following supporting
documentation to this application form. Failure to provide supporting documentation may affect
you receiving a scholarship offer.
Please read the Inspiring minds Equity Scholarship – Applicant information document, to
confirm what documents are required.
Evidence of Citizenship or residency status
Completed Centrelink Customer Consent form if you are a Centrelink Customer
Copy of recent Centrelink Statement if you are a Centrelink Customer
Evidence of being a recipient of a Department of Veterans Affairs grant/payment
Evidence of your rural address (i.e. drivers licence, high school report, official document with your
full postal address on it – not PO Box) if you have relocated.
Evidence of current address if you have relocated
Evidence of any dependants
23. Student Declaration
I declare that the information I have supplied within this application is true and correct to the
best of my knowledge. I understand if any false or misleading information is provided it could
lead to the cancellation of my scholarship. I also understand giving false or misleading
information is a serious offence under the Criminal Code.
I consent to the disclosure of relevant information for the selection process of this scholarship
Signature of Applicant:
Date:
Student Services Centre - Scholarships
Scholarships Telephone: +61 8 6304 3636 Fax: +61 8 6304 2088 Email: scho[email protected].au
Edith Cowan University
Centrelink Confirmation e Services (CCeS)
Customer Consent Record
Centrelink Confirmation eServices (CCeS) are internet-based facilities used by organisations like Edith
Cowan University (ECU) to confirm a Centrelink or Department of Veterans' Affairs (DVA) customer's
entitlement status to receive a concession or government allowance. CCeS assists Edith Cowan
University to ensure the eligibility of scholarship applicants by providing information as follows:
Centrelink Enquiry
ECU can utilise a Centrelink enquiry to:
a) Confirm a Centrelink customer's entitlement to receive a concession.
This type of enquiry only returns a YES or NO answer to Edith Cowan University.
b) Confirm the type of allowance a Centrelink customer receives.
This type of enquiry only provides the name of the allowance the Customer is entitled to.
Department of Veterans' Affairs (DVA) Enquiry
This enquiry is identical to a Centrelink Enquiry, except that it is used to specifically check DVA
customer’s eligibility for concessions.
I (insert full name)
authorise:
Edith Cowan University (ECU) to use Centrelink Confirmation eServices to perform a Centrelink /
DVA enquiry of my Centrelink or Department of Veterans’ Affairs Customer details and concession
card status in order to enable the business to determine if I qualify for a scholarship.
The Australian Government Department of Human Services (the department) to provide the
results of that enquiry to Edith Cowan University (ECU).
I understand that:
The department will use information I have provided to Edith Cowan University (ECU) to confirm
my eligibility for financial hardship and will disclose to Edith Cowan University (ECU) personal
information including my name, address, payment and concession card type and status.
This consent, once signed, remains valid while I am a customer of Edith Cowan University (ECU)
unless I withdraw it by contacting Edith Cowan University or the department.
I can obtain proof of my circumstances/details from the department and provide it to Edith Cowan
University (ECU) so that my eligibility for a scholarship can be determined.
If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may
not be eligible for the scholarship/award provided by Edith Cowan University (ECU).
ECU Student ID: _________________________________________
Student E-mail: _________________________________________
Centrelink or DVA
Customer Reference Number (CRN) _ _ _ _ _ _ _ _ _ _
Signature: __________________________________________
Date: __________________________________________
