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Application to the Catenian Charity Scholarship Fund Grants for tertiary tuition fees or tertiary residential college fees.Please complete all the sections (1- 9) below, and return the application to the Scholarship Master, at the email address below. Please type your answers . In this document “Charity” means the Catenian Charity Inc. W.A. Reg No. A1019114U

You MUST be an Australian Citizen and Roman Catholic to be eligible to apply.

The purpose of the Fund is to provide grants to marginalized and disadvantaged Australian students who have reached the age of 16 but not yet reached the age of 25 and are on low incomes and who cannot afford to pay either tertiary institution tuition fees or tertiary residential college fees. The grants must be paid to an Australian university or college by the student and are only available to Australian citizens. To be eligible applicants must be enrolled full time as a second year, third year or fourth year student in the graduate entry degree, or be enrolled in a Master’s degree.

This form is provided in Microsoft Word *.docx and *.doc format. The boxes for your answers will expand to accommodate answers longer than the box. Please keep your answers within the boxes provided.

Applicants are required to arrange for two confidential referee reports to be forwarded to the Scholarship Master with the application form by the application closing date. The referees should report on your drive and ambition, academic performance and capacity to pursue higher studies.

It is the applicant’s responsibility to ensure that the referees’ reports are received by the “Charity” with permission granted by the referees for the “Charity” to contact them directly. To enable this to be done in addition to this application form, applicants are provided with an Referee Report for completion and signature, by

of 24 document.docApplication Reference Number

Referees. Please note: Referees are not to be related to the applicant.

Please submit your completed application forms with supporting documents by email to:

The Scholarship Master at info.bryantchurch.com.auNote: Please keep a copy of your application and the attachments for your records, please send scanned certified copies of the original documents.

Please ensure that all documents in support of your application are marked with your Application Reference Number, shown in the footer of each page of this application form .

Further enquiries or additional information: If you have any questions in relation to the completion of the application form, referee reports, additional information to attach, or of the scholarship fund in general, please contact the Scholarship Master at the above email address on page 1.

Privacy policyThe “Charity” respects the privacy of individuals and acknowledges that the information you provide on this form is ‘personal information’ as defined by the Commonwealth Privacy Act. The information is being collected for the purposes of assessing your eligibility for a grant from the “Charity” and processing your application for a grant. The provision of this information is voluntary, but if it is not provided the “Charity” may be unable to process your application. The information provided will be viewed by Board of the “Charity”. For more information on the privacy policy, or to obtain a copy, please contact the “Charity”.

Please insert a passport style photo of yourself in the box below.


Section 1. Purpose of the Grant and amount Required.

Purpose of Grant

Amount of Grant Required


Section 2. Personal Details

Title: Mr /Mrs /Miss/ Ms / OtherGiven Names (in full)

Preferred Name

Family Name

Gender

Date of Birth dd/mm/yyyy

Section 3. Contact Details

Street Suburb Postcode State

PO Box Address State Post Code

Country

Email

Mobile Phone Fax

Term Address for (Please insert Year) OppositeStreet Suburb Post

Code State

Preferred Contact Details

Street Suburb Post Code

State


PO Box Address Suburb Postcode State

Section 4. Educational detailsPlease list the details of both your secondary and tertiary qualifications. Certified copies of your qualifications must be attached.

Secondary qualificationsCompleted Year

12School / College Date completed

Please detail any courses you have completed

Tertiary qualificationsName of tertiary institution (e.g. University or College)

Name of Degree or Diploma (e.g. Bachelor of Commerce)

Year of Degree Date Commenced Do you Study Full Time or Part Time

What course have you applied for in (please enter the year yyyy)

Enter Course

What was your previous course of study

Name of Degree Institution


Date of Completion Results

Please provide a copy of your academic transcript for previous degree and for the academic course to date.

Section 5. Current Financial information.5.1 Do you personally receive a means tested Commonwealth

income support payment (i.e. Austudy, Youth Allowance, Abstudy etc.)?

X XYes, please complete Questions 5.2 No please go to

Questions 5.3

5.2 Please tick the relevant box and detail the gross amount you receive per fortnight

X Allowance Amount per fortnight

Youth Allowance

Austudy

Abstudy

Disability Support Pension

Pensioner Education Supplement

Sole parent Pension

Carer Pension

Veterans’ Affairs Payment


Please include a copy of a current Centrelink income statement dated within the last 3 months or other appropriate documentation confirming the level of your current payment. Such a statement can be obtained by phoning Centrelink on 13 24 90. Please allow 4-5 working days from the date you request the statement and factor this into the timeline in respect of the closing date for grant application. Alternatively, you can go into a Centrelink office to request a statement over the counter.

5.3 Please indicate your statusX X X

Single (Living at home)

Single (Independent)

Sole parent / Carer

Partnered, no dependents

Partnered, dependents

Other, specify below

5.4 What is your gross average fortnightly income

Please Enter Income Year in box below

If you are not sure of your income or expenses, please provide your best estimate of your financial situation for the year you have entered above

X Please Select Source of IncomeIndividual Income


Partnered/Combined Income

Family Income (If you are dependent on your family’s income)

Fortnightly IncomeSalary/Wages (gross)

Commonwealth Support payment (e.g. Austudy, Youth AllowanceAssistance from family

Child support

Scholarships/grants/awards

Other (e.g. Shares, Investments interest, trusts etc. Total Fortnightly Income


5.5 What are your average fortnightly expenses.X X

Individual Expenses

Partnered/Combined Expenses

Family Expenses (If you are dependent on your family’s income)

Expense AmountRent / Board / Mortgage

Food / Groceries

Phone / Power /water

Transport (Transperth, car costs, including insurance, registration etc.)

Loan repayments

Childcare

Incidentals / other

Total Expenses

5.6 What is your average fortnightly Deficit / Surplus?

Deficit Surplus


5.7 Have you ever applied for a means tested Commonwealth income support payment?

XYes, If No go to 5.7.1

For what type of payment did you apply

When did you apply

If your application was declined, please provide details as to the reason why (e.g. Level of parent’s income, value of family farming property, level of family assets etc.

5.7.1X

No

Why have you not applied?


5.8. Have you been awarded any other scholarship to assist your university expenses or living costs?

XYes

No

Name of ScholarshipAmount

Date Awarded

Frequency of PaymentDuration of Scholarship

5.9 Responsibility for Others

X Do you have Responsibility for Others?Yes – Please go to 5.9.1

No Please go to section 5.10

5.9.1 If you do have responsibility for others, what level of care do they require? (e.g. an elderly parent, sibling who lives in or requires part-time care, or care for someone with a disability or medical condition)


5.9.2 Please comment if any of your dependents have special needs

OTHER INFORMATION (all applicants)

Please note that the information you provide here will help the in assessing your suitability for a grant. All information will be treated in the strictest of confidence.

5.10 Do you have a disability or chronic medical condition?


XYes - please refer to Section 6 below and comment how your conditions affects your ability to study and/or your enrolment in your Personal Statement

No

If ‘yes’ please provide a statement from your medical practitioner or other suitably qualified health provider detailing your medical condition or disability. The medical report should include comment on the severity of your condition or disability and how it affects your ability to study.


Section 6 Personal DetailsThe following questions are designed to assist in the review of your

application: Were you born in Australia?

Were your parents born in Australia? Did your parents complete a University degree?Do you have difficulty with the English languageHow well would you say you speak English?

Do you have a condition which requires assistance?

YES NO

No need for assistance

Short-term health condition (lasting less than six-months)

Long-term health condition (lasting six-months or more)

Disability (lasting six-months or more)

Other


Section 7.0 PERSONAL STATEMENT (Compulsory)How would receipt of the scholarship assist you in the limitations you

have identified?If there is any information which has not been covered in your answers but which is important in the assessment of your application please provide details here e.g. Information about your personal or family background, unique financial circumstances, time taken to commute to university from an outer suburb, etc.

Comments should be a minimum of 300 and a maximum of 600 words. Please also include relevant documentation to support your comments


Section 7.0 PERSONAL STATEMENT (Compulsory) Continued.


Section 7.1. Further Studies detailsDetail the reasons that you want to undertake further study and why you have selected this course of study.


Section 7.2 Career aspirationsPlease outline your career aspirations.

Section 8 References Applicants are required to arrange for two confidential referee reports to be forwarded to the Scholarship Master with the application form by the closing date. The referees should report on your drive and ambition, academic performance and capacity to pursue higher studies. It is the applicant’s responsibility to ensure that the referees’ reports are received by the “Charity” with permission granted by the referees for the “Charity” to contact them directly. Please provide your referees with a copy of the Catenian Scholarship Fund Referee Report Form which has been sent to you with this application form.


Please give details of your Referees below.

Referee 1

Title

Given names in full

Family Name

Position title

Employer /Company nameEmployer / Company addressMobile Number

Phone Number

I have known this Referee for:

Years Months

Referee 2

Title

Given names in full

Family Name

Position title

Employer /Company nameEmployer / Company


addressMobile Number

Phone Number

I have known this Referee for:

Years Months

Section 9 Declaration.

Please print this page and initial the blue boxes and sign the yellow box, then scan the signed page and submit with your application for a scholarship.

Please Initial the relevant box opposite the questions below, indicating your agreement to the conditions set forth therein. In consideration of the “Charity” evaluation of my application for a scholarship:

1 I agree to produce such further evidence and information in relation to this application as may be required by the “Charity” and attest that the information is true and correct

2 In consideration of the “Charity” evaluation of my application for a grant, I understand and agree that confirmation of my responses may be sought. These checks may include, but are not limited to, verification of my qualifications and financial circumstances.

3 I hereby authorise the “Charity” and its authorised nominees to collect, use, disclose and store personal information about me from third parties, for the purpose of verifying the information provided in my application.

4 I allow third parties holding personal information about me to release such information to the “Charity” and its authorised nominees.


5 I agree to my first name, state and generalised description of circumstances being used in the promotion of the “Charity” should I receive a grant. I understand that I will be given the promotional content to review and authorise prior to publication.

6 I agree to produce evidence that I have paid the amount of the grant to the tertiary institution or the tertiary residential college as the case may be and allow the tertiary institution or the tertiary residential college to verify such payment information to the “Charity”.

Signature Date


Section 10 Check List

To ensure your application is complete and can be processed, please review the checklist below and ensure all relevant documentation is attached. Completed all sections of the application (1 – 9)

Document X

CV/Résumé

Proof of Australian citizenship (e.g. Certified copy of Birth Certificate / Australian Certificate of Citizenship

Proof of Membership of the Catholic Church e.g. Baptism Certificate

Secondary education: A letter/documentation confirming you were in Year 12, signed by the School Principal (if applicable)

Tertiary education: A letter/documentation confirming your acceptance of studies or current studies in a degree

Copy of most recent Tax Return (if applicable)

Copy of a current Centrelink income statement dated within the last 3 months or other appropriate documentation confirming the level of your current payment.

Two Referees Reports


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