koori tertiary scholarships - victoria university · pdf fileapplication for koori tertiary...

Koori Tertiary Scholarships APPLICATION FORM

An initiative of the Victorian Aboriginal Justice Agreement

Intake commencing – Semester One of the official academic year of 2014

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APPLICATION FOR KOORI TERTIARY SCHOLARSHIPS SEMESTER ONE 2014

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The Koori Tertiary Scholarship Program

The Department of Justice Koori Tertiary Scholarship Program promotes career development opportunities for Aboriginal and/or Torres Strait Islander in justice related fields of study including law, criminology, para-legal, psychology, psychiatry, social work and mental health. Other justice related fields of study may apply.

Please complete this application form if you are an Aboriginal and/or Torres Strait Islander and wish to apply for a Department of Justice Koori Tertiary Scholarship. Please carefully read the Koori Tertiary Scholarship Program Guidelines: Applying for academic intake and commencement of study in Semester 1, 2014 before submitting your application. A limited number of scholarships will be awarded on the basis of merit.

Completing and submitting your application

Please forward all enquiries, and your completed Department of Justice Koori Tertiary Scholarship Program application to:

Jeffrey Gray

Administration Officer

Koori Employment Team

Department of Justice

Tel: (03) 8684 1751

Fax: (03) 8684 0034

Email: [email protected]

Deliver by post GPO Box 123

Melbourne VIC 3001

(If you lodge your application by mail, please call prior to the closing date to confirm your application has been received).

Deliver by hand Please call in advance

Level 37, 121 Exhibition Street

Melbourne VIC 3001

mailto:[email protected]


Details of supporting evidence/documentation required for submission with your application is provided throughout this form. To make it easier for you, the symbol (on the left) can be found wherever required documentation is requested.

Incomplete or late applications may not be accepted. It is your responsibility to ensure that all documentation, as requested be provided with your application. This includes referee reports, course information, enrolment details and other supporting documentation. Your application may not be considered if all documentation is not attached.

Every effort will be made to expedite the decision making process and applicants will be notified of the result of their scholarship application in writing as soon as possible after the closing date.

Koori Tertiary Scholarship Program applicants may be asked to come for an interview to expand on their application.

Closing date for completed applications and attached supporting documentation is by close of business at 5pm, 28th February 2014.

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Applicant Checklist

Tick the following and submit with your application. Have you:

Read through and understood the guidelines?

Met all of the eligibility criteria?

Completed all questions?

Signed the declaration at the end of the application form?

Attached a letter of enrolment?

Attached a letter of admittance?

Attached academic results?

Provided a copy of your ‘Proof of Aboriginality’

If you are undertaking Postgraduate study, have you attached a completed Academic Referee Report

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Personal details

Title Surname

(eg.Mr, Mrs, Ms etc.)

Given names

Date of birth (day / month / year)

Contact details

Residential address

Suburb/town State Postcode

PO Box (if any)

Please tick one of the following telephone numbers as the best to reach you on during the semester.

Home telephone Mobile

Other telephone

Email

It is essential that you are contactable throughout the period of your scholarship. Please promptly notify the Contact Officer (contact details page 2), of any change of contact details during this time.

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Declaration of eligibility

To be eligible for a scholarship, you must:

(a) Have resided in Victoria on a full-time basis for a minimum five-year period immediately preceding lodgement of application. Residency details are requested on the Application form. Additional documentation may be requested after the closing dates.

Do you satisfy the above eligibility criteria? Yes No

(b) Not earn in excess of $20,000 gross per annum from employment undertaken throughout the duration of the scholarship (the maximum increases to $10,000 per annum additional for each dependent).


(c) Have not been in receipt of a scholarship offering financial assistance for study purposes by the Victorian State Government, which exceeded $20,000, over the past five years.


(d) Meet the following four requirements:

be of Aboriginal and/or Torres Strait Islander descent

identify as an Aboriginal and/or Torres Strait Islander

be accepted as such by the Aboriginal and/or Torres Strait Islander community in which you live or have lived

have provided a copy of your ‘Proof of Aboriginality’.


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To be considered for a scholarship, you must also meet the following eligibility requirements, applicable to your study. You must:

(e) Be undertaking your studies at an approved Victorian educational institution and:

have successfully completed the first year of an Undergraduate degree course in the discipline for which the application is being made, or

have successfully gained entry into a Diploma or Advanced Diploma course in the specific courses as stated in these guidelines, or

have successfully gained entry into a Postgraduate course for which the scholarship application is being made.

(f) Be an undergraduate applicant who has successfully completed all units of a full-time workload within one year, in the previous three years and as determined by the educational institute at which you are studying, and be:

undertaking a full-time work load, as determined by the educational institution where you are studying or

be enrolled to undertake a full-time work load, as determined by the educational institution where you are studying or

undertaking part-time study, through course work, to satisfy the formal component of an Articled Clerkship at an approved institution or at the College of Law (Sydney, New South Wales).

Please ensure you enclose a copy of your ‘Proof of Aboriginality’ with this application.

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Course of study details

Please provide your study details for 2014 by completing the following. You must also provide proof of your enrolment.

Please tick the boxes which are applicable to your study

Diploma course (full-time only)

Undergraduate course (full-time only)

Postgraduate course (full-time only)

Exact course title

(e.g. Bachelor of Arts)

Course code

Name of institution or college

Address of institution or college

List of subjects you will study in

Semester 1, 2014

Official Semester 2, 2014

commencement date for studies

Which year of study are you undertaking?

(e.g. second, third or fourth year)

Expected completion date of course

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Have you already enrolled in the course? Yes No

Have you already gained admittance into the course? Yes No

Have you already commenced in the course of study? Yes No

Have you already undertaken any course prerequisites? Yes No

What credits points have you gained for study already undertaken?

What is to the total number of credit points you require to complete your

course/degree? (This figure should include the points already gained)

If the course of study for which you are applying for a scholarship is longer than one year, please list below the subjects, by semester, for future years.

Semester 1 2 Year First Second Third Fourth

Subjects


Subjects

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Subjects


Subjects


Subjects

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Subjects


Subjects

Educational achievements

If you have attempted or completed any other study since leaving secondary school, please outline all courses that you have completed and provide copies of your academic record/achievements. (e.g. Certificate, Diploma, Undergraduate or Postgraduate). If not, please include your highest secondary school year.

Years Completed Not yet completed

Name of course

Name of institution Completed Not yet completed

Years

Name of course

Name of institution Completed Not yet completed

Years

Please attach the following to submit with your completed application:

a photocopy (certified) of enrolment details of your course

if applicable, any results for subjects already undertaken for which you have gained credit

clear, certified copies of your official academic record to date, as issued by each institution.

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Supporting statement

In your own hand-writing and in around 600 words, please tell us of your personal and career aspirations and how your aims might be met by undertaking your proposed course of study?

(You may wish to express how your local or other Aboriginal and/or Torres Strait Islander community may benefit from your acquired qualifications at the end of your study).


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(Please attach additional pages of comment to the application if further space is required.)


Other scholarships

Have you previously received a scholarship from the Victorian State Government, which provided financial assistance of more than $20,000, for tertiary study within the past five years?

Yes (please provide details below) No

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Name of scholarship provider

Duration of scholarship (years)

Year scholarship commenced

Name of course

Name of institution

Have you applied for other scholarships for your 2014 study?

Yes (please complete the following question) No

Have you received notification that you have been successful in securing a scholarship for your current or proposed study?

Yes No

It is the responsibility of the applicant to notify the Contact Officer (contact details page 2) of any offer of financial assistance for proposed study after your application has been lodged.


Academic referee details

For applicants undertaking Postgraduate study only.

Please request your referee to complete Attachment A: Academic Reference for Postgraduate applicants (on pages 11-13 of this application), to comment on your academic abilities.

Name of academic referee

Name of institution

Role within the institution

Address of institution

Referee telephone number

Referee mobile number

Referee email address

Declaration

(All applicants to complete and sign the following declaration)

I declare that the information supplied by me on this application form is complete, true and correct in every detail. I acknowledge that Department of Justice may terminate any scholarship and associated allowances if I have misrepresented my past and/or present circumstances and that this termination may take place at any stage during the proposed course of study as detailed in this application.

I authorise the Department of Justice to obtain official records with respect to my enrolment, academic record, examination results, details of my work history, attendance and contact addresses throughout the duration of the scholarship. Such information is in accordance with my application for a Koori Tertiary Scholarship and with regard to any benefits payable to me under the Department of Justice Koori Tertiary Scholarship Program award.

I agree to abide by the Department of Justice conditions of the Koori Tertiary Scholarship Program as may be amended from time to time.

Applicant’s full name

(please print)

Applicant’s signature

Date signed (day / month / year)

For details on completing and submitting your Department of Justice Koori Tertiary Scholarship Program application, please refer to page 2 of this document.

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Attachment A:

Academic reference for Postgraduate applicants

The following academic reference is to be completed by Postgraduate study applicants only, for the Department of Justice Koori Tertiary Scholarship Program.

FOR ACADEMIC REFEREES

The following applicant has made an application for a Department of Justice Koori Tertiary Scholarship, for Postgraduate studies.

It is required that each Postgraduate applicant provides an academic reference to be considered by the Department of Justice with their application.

This reference will be treated in strict confidence. You may wish to discuss your comments and assessment with the applicant.

Please complete the relevant areas of the following form and return it directly to the applicant, to be attached to the Koori Tertiary Scholarship Program application form.

Please note that the closing date for applications is 5pm, 28th February 2014.

If you have any queries about completing this form, please contact:

Jeffrey Gray

Administration Officer

Koori Employment Team

Koori Justice Unit, Department of Justice

Tel: (03) 8684 1751

Fax: (03) 8684 0034

Email: [email protected]

mailto:[email protected]


Applicant details

(Applicant to complete)

Title Surname

(eg.Mr, Mrs, Ms etc.)

Given names

Date of birth (day / month / year)

Proposed course title

Academic referee details

(Applicant to complete)

Name of academic referee

Name of institution

Role within the institution

Address of institution

Referee telephone number

Referee mobile number

Referee email address

Please provide details of the course of study where your academic referee has had involvement.


Name of course

Name of institution

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Name of course

Name of institution

Academic reference

(Referee to complete)

Please give your appraisal of the applicant in terms of the qualities listed below. Rate the applicant in comparison with others you know who have undertaken graduate study.

Imagination/Creativity

Exceptional Top 10% Top 20% Top 50% Unable to judge

Analytical ability


Organisational ability


Written and Verbal Communication


Persistence/Maturity


Application and commitment to academic study


Time management and meeting of assignment timeframes


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Any further comments you wish to make about this applicant’s academic performance:

Academic referee’s name

(please print)

Referee’s signature

Date signed (day / month / year)

END OF APPLICATION

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