2019QIC Indigenous

Tertiary Scholarship

Application form

SECTION ONE: PERSONAL DETAILS

Student number       Gender

Title First name       Family name     

Address and contact details

Street      

Suburb       State       Postcode      

Telephone (home)       Mobile      

Email      

Where did you find out about the QIC Indigenous Tertiary Scholarships?

Email Website Lecturer Another student Other      

Are you and Australian Citizen or permanent resident?

Yes No

SECTION TWO: ACADEMIC RECORD AND PROFESSIONAL QUALIFICATIONS

What course are you studying at QUT? Major

           

Will you be enrolled full-time at QUT in 2019?

Yes No (Proof of enrolment will be verified prior to payment after course dates)

Please indicate the course you are enrolled in

List any special awards, prizes or other achievements you have accomplished

     

If successful, do you agree to undertake the course full-time during the term of the scholarship in 2019?

Yes No

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SECTION THREE: SCHOLARSHIPS RESPONSE QUESTIONSA written submission of 500 words or less, for each question, in your own words

1. Give examples of your academic ability and potential to achieve at university.

     

2. Describe your personal attributes e.g. community involvement, career aspirations,

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interests, drive, ability to overcome adversity.

     

3. Impact of the scholarship. How will the QIC Indigenous Tertiary Scholarship assist you in achieving your current and future career goals?

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SECTION FOUR: SUPPORTING EVIDENCEApplicants should attach documentary evidence of additional material that they believe will support their scholarship application, including: academic transcripts (from high school, TAFE and/or current/previous study) academic transcript if a continuing QUT student (Please attach a copy of your academic record

from QUT Virtual) certified copy of documentation supporting Aboriginal and/or Torres Strait Islander heritage (if

not already provided to the Oodgeroo Unit, QUT) a current resume/curriculum vitae referee reports, published research etc evidence of Australian Citizenship or permanent residency

SECTION FIVE: DECLARATION I declare that, to the best of my knowledge and belief, all the information I have provided is

true and correct. I understand that the submission of false information in my application will result in the disqualification of my application.

I have read and understood the conditions of this scholarship and have included the required documentary evidence (see checklist on page 6).

I agree to assist with promotion of the scholarship through participation at Oodgeroo Unit, QUT and QIC promotional/recruitment events if required.

Signature       Date      

TAX AND OTHER BENEFITS IMPLICATIONSScholarship payments will contribute to recipients’ taxable income and may also impact entitlement to Commonwealth benefits such as ABSTUDY.Scholarship applicants and/or recipients are encouraged to contact Centrelink, the Australian Taxation Office (ATO) and/or their taxation agent to obtain advice about the implications of the scholarship payments on current earnings and benefits.Information about taxation on scholarships is also available from the ATO website at: https://www.ato.gov.au/Calculators-and-tools/Is-your-scholarship-taxable

PRIVACYThe Oodgeroo Unit, QUT collects the personal information on this form to assess your scholarship application and for other University purposes upon enrolment. Information explaining how QUT manages students' personal information can be found at http://www.governance.qut.edu.au/compliance/privacy

QIC INDIGENOUS TERTIARY SCHOLARSHIP: APPLICATION CHECKLISTThe following documentation is required to support your completed QIC Indigenous Tertiary Scholarship application form.

academic transcripts (from high school, TAFE and/or current/previous study) academic transcript if a continuing QUT student (please attach a copy of your academic record

from QUT Virtual)

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certified copy of documentation supporting Aboriginal and/or Torres Strait Islander heritage (if not already provided to the Oodgeroo Unit, QUT)

a resume/curriculum vitae referee reports, published research etc evidence of Australian Citizenship or permanent residency (where applicable)

To submit your application complete the QIC Indigenous Tertiary Scholarship application form email all supporting documents as listed above to information.oodgeroo@qut.edu.au by the

closing date.

APPLICATIONS CLOSE FRIDAY 1 MARCH 2019

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