Roy Ampt Memorial bursary application form

While no specific documents are required for this bursary, you may wish to include any documents that support your application. Combine documents into a single file if you have multiple files.

Any other documents that you think may assist in explaining your application

Personal details

First name (required)

Surname (required)

Student ID Number

Mobile (required)

Email (required)

Citizenship/residency status (required)

Australian Citizen

Australian Permanent Resident

New Zealand Citizen

International student

Aboriginal and Torres Strait Islander background (required)

Neither Aboriginal nor Torres Strait Islander

Aboriginal

Torres Strait Islander

Aboriginal and Torres Strait Islander

Student type

Commencing

Current

Alumni

Course details

<e.g. Course name; year of study if current; special program info etc.>

Financial Details

Do you receive a means tested Commonwealth income support payment (i.e. Austudy, Youth Allowance, ABSTUDY etc.)?

Yes

Are you currently a recipient of any other scholarship to assist with your university expenses or living costs?

Yes

Please select the option that best describes your situation

Single (Living at home)

Single (independent)

Sole parent/carer

Partnered, no dependants

Partnered, dependants

Other (specify)

Document upload

Conditions

I accept the conditions of the scholarship/grant I am applying for as documented in the information brochure

Student Declaration

Privacy and Confidentiality Statement

ALC will not disclose any information supplied in this Application Form without written consent of the applicant below. The information supplied will only be used for the selection process of the scholarship(s). See the ALC Privacy Policy.

By submitting this form, I authorise ALC to share my information supplied in this Application Form to the relevant persons, only where it is for the purposes of the selection process of the scholarship(s).

I understand that this may include the relevant staff members of ALC and panel members specific to the selection process (and this may include the relevant third-party donors of scholarships who are panel members in the selection panel).

By submitting this form, I declare that the information that I have supplied on this form is true and correct to the best of my knowledge.

I understand that my funding may be cancelled if it is proven that I was offered a scholarship/grant based on false or misleading information or documentation.

Your application