Destination Australia Scholarship Application form The Destination Australia scheme seeks to attract and support new domestic students to study in regional Australia and offers a high-quality learning experience. This scholarship offers students the opportunity to experience regional Australia. Note: Only domestic students undertaking a full time load will be eligible for the Destination Australia scholarship. Required fields are marked with an asterisk (*). Citizenship * I am a domestic student I am an international student International students please visit the International site. Will you be undertaking a course at La Trobe University at a regional campus on a full time basis? Yes No Sorry, you are not eligible. Do you live in a Regional / Rural area? or do you intend to be living regionally / rurally to study in 2024? If you haven't secured accommodation in a rural or regional area at the time of application, you will be asked to supply this at a later time. Yes No Sorry, you are not eligible. Your addressStreet address City / Suburb / Town Postcode My details Given name * Family name * Student ID number Please add if you have a La Trobe student ID or leave blank if not. Email * Phone * Date of Birth * Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJuneJulyAugSeptOctNovDec Year 19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 Gender * Female Male Neutral/Indeterminate/Intersex/Unspecified Supporting information Please confirm which degree you are studying or planning to study in Semester 2, 2024 * Select the regional campus you are or will be studying at * -- Please Select --Albury-WodongaBendigoMildura Shepparton Do you identify as being from a culturally and linguistically diverse background? * Yes No Are you or will you be the first person in your immediate family to attend university? * Yes No Are you of Aboriginal Australian or Torres Strait Islander descent? * Yes No Have you ever spent time in formal out-of-home care? * e.g. foster care, residential care, kinship care or been a ward of the state. Yes No Specify the type of care How long were you in formal out-of-home care? Are you or have you been a refugee? Yes No What is your household structure? Live alone Live with flat mates Live with my spouse/partner Live with parents/guardians Live in single parent/guardian household Do you have children? Yes, I have children No, I do not have children Parenting I am a sole parent I share custody of children The number of children less than 16 years of age The number of children 16 years of age or older Do you have a medical condition or disability which impacts your ability to study? Examples of medical conditions and disabilities include but are not limited to: Physical impairment (e.g. blindness), Learning disabilities (e.g. dyslexia), Chronic pain, Eating disorder (e.g. anorexia), Mental illness (e.g. depression), Major illness (e.g. cancer) Yes No Name of condition Duration of condition (months/years) Briefly describe your condition/disability, the impact, timing and how they have adversely affected your education or ability to pursue education. Your personal statement must include the duration and the impact of your condition. (to receive consideration for this criteria, you will be required to provide evidence, see below) Personal statement max 2500 characters Statement of support from a medical professional You must provide a recent (within 12 months) statement of support from a medical professional who treated or is currently treating your condition(s)/disability. Ensure the contact details of the professional and date is included. PLEASE NOTE: .pdf file type ONLY. Max file size 8MB. Has your education been adversely affected by your financial circumstances, or do you expect your tertiary education to be adversely affected by your financial circumstances? You will be required to provide evidence Yes No Do you, the applicant, currently receive any Centrelink benefits? e.g. Youth Allowance or health care card Yes No Please provide evidence of your current Centrelink benefit(s) such as an Income Statement dated within the last three months or both sides of your current Health Care Card. For information on suitable evidence check our supporting documentation requirements website. (.pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB) Upload the other side of your current Health Care Card. What is the gross income of your household? -- Please Select --$0-20,000$20,000-$30,000$30,000-$40,000$40,000-$50,000$50,000-$60,000$60,000-$70,000$70,000-$80,000$80,000-$90,000$90,000-$100,000$100,000-$110,000$110,000-$120,000$120,000+ How many household members (including yourself) are dependent on the household income selected above? -- Please Select --123456789 or more Please provide evidence of all household income contributors. (e.g. Australian Tax Office Notice of Assessment for 2020-2021, or 3 consecutive pay slips dated within the last 3 months, .pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB) Has your education been disadvantaged by difficult circumstances not outlined above? (examples of difficult circumstances may include abusive family circumstances, excessive carer duties, chronic medical condition of a child, death of close relative, homelessness, recent multiple relocations, recent separation of parents, relationship breakdown, victim of crime, bullying.) Yes No Please provide evidence to describe the impact and timing, and how it has adversely affected your education or ability to pursue education. Please provide a statement of support about your difficult circumstances. (This may be in the form of a SEAS Statement, death notice, police report or statement by a relevant responsible person. For example; health care professional, social worker, counsellor, religious or community leader, school principal or teacher etc, unrelated to you as the applicant, who can verify the circumstances. Statements of Support must be recently dated (within 12 months), on letterhead or include contact details of referee. Statement must include duration and impact of the circumstances. *Applicants who do not supply supporting documents will not be scored for difficult circumstances. .pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB) Provide a personal statement demonstrating how this scholarship will help you and your commitment to supporting the regional community where you will be studying. Please outline any obstacles you have encountered in accessing higher education and how the scholarship will assist to overcome these. You should indicate why you are interested in studying the course in a regional location and how you believe you will contribute to the region. Do you intend to stay and work locally? (Max 500 words) Privacy All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information in your application to determine your eligibility for a scholarship, bursary or grant, and to assess your application as part of the ranking and allocation process. In accordance with privacy laws, personal information about you contained in your application will not be used for any other purpose or disclosed to any person who is not part of the La Trobe assessment and allocation process, without your permission. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting the Scholarships Office. The La Trobe University privacy policy can be viewed at: www.latrobe.edu.au/privacy Validation
