CURTIN UNIVERSITY INTERNATIONAL UNDERGRADUATE SCHOLARSHIPS 2012 Application Form

Given Name(s): Family Name:

Student Number:

If you are unsure of which scholarship you are eligible to apply for, please refer to the Applicant Information sheet available at the Curtin scholarships website www.scholarships.curtin.edu.au

I am applying for: (Please indicate below which scholarships you are applying for)

CBS International Innovation Scholarship Information Systems Scholarship

Instructions:
Please read all sections All applicants must complete Sections 1, 2, 3, 4 and 5

Application Closing Date 5th December 2011

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Section 1: General Eligibility

1.1 Are you an International Student? Yes No - You are ineligible for this Scholarship do not continue 1.2 To be eligible for this scholarship you must hold a valid Student Visa Higher Education (Subclass 573) Are you a holder of this Visa type? Yes No you are ineligible for this Scholarship do not continue

What is your country of citizenship? ___________________________________________________ In which country were you born? _____________________________________________________

1.3 Is 2012 the first time you will undertake study in an undergraduate degree course (either at Curtin or elsewhere)? Yes No You are ineligible for this Scholarship do not continue

1.4 To be eligible for these scholarships, you must be enrolled as a full-time student studying 100 credits per semester unless you can demonstrate exceptional circumstances. Will you be studying 100 credits per semester in 2012? Yes No Please provide details as to why you are claiming that there are exceptional circumstances preventing you from studying full-time, e.g. disability, carer responsibilities, etc. Please provide relevant documentary evidence to support your statement.

1.5 Have you been awarded or are currently applying for any other scholarships to assist you to meet your University expenses or living costs? Yes Name of Scholarship: _________________________________________________ Amount:____________________________________________________________ Date warded/applied:_________________________________________________ Frequency & duration of payment:_______________________________________

No

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Section 2: Scholarship Specific Eligibility

2.1

CBS International Innovation Scholarship

To be eligible for this scholarship you must apply/or be enrolled in one of the following courses:
Bachelor of Commerce (Business Information Systems)- single major Bachelor of Commerce (Business Information Technology) - single major Bachelor of Commerce (Business Information Systems and Technology)- double major

Are you enrolled in one of these courses? Yes No - You are ineligible for this scholarship do not continue

2.2

Information Systems Scholarship Program

To be eligible for this scholarship you must apply/or be enrolled in one of the following courses:
Bachelor of Commerce (Business Information Systems) Bachelor of Commerce (Business Information Technology) Bachelor of Commerce (Business Information Systems and Technology)- double major

Are you enrolled in one of these courses? Yes No - You are ineligible for this scholarship do not continue

Section 3: Personal Details

3.1 3.2 Date of Birth: 3.3 Semester address: Male Female

Permanent home address if different from above

Email address: Phone number: Mobile number:

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3.4 What year did you complete High School?

Name of School attended Years 11 and 12

3.5 Course enrolled or applied for: (eg. Bachelor of Engineering - Chemical)

Section 4: Personal Statement

4.1 Please write and attach to this application a personal statement outlining the following:

(Your responses should be 2 pages maximum 800 words in total - Write your name, student number and the title of the scholarship that your statement relates to on each additional page. Please attach relevant documentation to support your statement) a) b) c) d) e) Your reasons for choosing to study your degree What you wish to achieve in your future and what your commitment and personal aspirations regarding your career is Outline details of any experience you have had within your chosen field How do you feel you would benefit from a scholarship if your application was successful and what impact do you believe it would have on your future within the desired industry? Please write and attach to this application a statement addressing the following: (1 page maximum - 400 words - Write your name, student number and the title of the Scholarship that your response relates to on each additional page) Explain how you could use information systems and technologies in a new and creative way to improve an organisation you are familiar with. The improvement should lead to the organisation meeting its goals more effectively or an improvement in its efficiency.

Section 5: Supporting Documentation and Application Checklist:

Have you completed all the questions relevant to the scholarship you are applying for? Have you signed and dated your application? Have you had your application witnessed?

Please Note: Applicants who do not include all the correct supporting documentation requested will be deemed ineligible All documents must be certified copies of originals. For details on certification go to: http://scholarships.curtin.edu.au/undergraduate/documents/CertificationGuidelines.pdf No other copies (including faxes) will be accepted.

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Documentation to be submitted with ALL applications: Responses to Section 4 Copy of Visa (certified copy) Copy of Passport (certified copy) If applicable additional documentation to be submitted with your application: Copy of Canning College results (certified copy) (Canning College Bursary Applicants ONLY) Copy of Canning College certificates (certified copy) (Canning College Bursary Applicants ONLY) Supporting documentation for your personal statement in Section 4.1.

Privacy and Confidentiality Statement Curtin University will only use personal information collected from you, or about you, for internal administrative purposes. It will not be provided to other parties other than in accordance with legislative requirements or in circumstances where you have given explicit permission for the information to be transmitted. Student Declaration I hereby certify that the information and supporting documentation provided in this application is complete and correct. I agree that Curtin University may, verify details of my educational qualifications. I understand that my Scholarship may be cancelled if it is proven that I was offered the Scholarship based on false or misleading information or documentation.

Signature of Recipient: Name of Recipient: Student Number: Date:

Signature of Witness: Name of Witness: Position or Relationship to Recipient: Date:

Your completed application should be delivered: in person to Scholarships Office Student Central Building 101, Level 1 Curtin University Kent Street BENTLEY WA 6102 or posted to Scholarships Office Student Central Building 101, Level 1 Curtin University GPO Box U1987 PERTH, WA 6845

If you have any questions regarding the application process, please contact the Scholarships Office at email scholarships@curtin.edu.au or phone (08) 9266 2992.

GOOD LUCK WITH YOUR APPLICATION!

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