Step 1 Personal Details. First Name:

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Jane Ball
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1 Step 1 Personal Details Title: Mr First Name: John Last Name: Citizen QTAC Number: Your QTAC number is the reference number which you receive after you have lodged a QTAC application online. Your QTAC number will begin with a 16 (or a 15 if you are a gap year student who applied through QTAC in 2014). Date of Birth: 01/01/1996 If you decide to accept a place at university will you be the first person in your immediate family (father, mother, sisters and brothers) to attend university? Do you identify as an Australian Aboriginal or Torres Strait Islander person? If you answered yes, you will need to provide evidence of your Indigenous status. Step 2 Contact details Australia Address Line 1: University Drive Suburb or Town: ST LUCIA State: QLD Postal Code: 4072 International Address Line 1: Address Line 2: Suburb or Town: State: Country: Postal Code: Home Phone: Mobile Phone: address: (Note: International for Australian citizens completing senior studies overseas)

2 Step 3 Citizenship Details Australian Citizen Other Step 4 School Details In what year did you / will complete year 12? Are you completing the International Baccalaureate (IB)? Yes No Is your current school a public (i.e. State High School or private / independent school? Public Private Please enter the full name and location of your secondary school. Name: Suburb or Town: Post Code: Country:

3 Step 5 QTAC Information The University of Queensland must be listed as either your 1 st or 2 nd QTAC preference to be considered for an Academic Scholarship. The Selection Panel will be guided by your highest UQ preference listed. Please indicate your 1 st and 2 nd QTAC preferences below: First Preference Name of University: Study Area: Degree Name: Second Preference Name of University: Study Area: Degree Name:

4 Step 6 Exceptional Academic Achievements In years 11-12, have you been a medallist or state/national finalist or received a high distinction in any state, national or international academic competition? Please see the list below for examples. Please do NOT include Participation, Credit, Distinction awards or School Subject awards. Australian Informatics Olympiad Australian Mathematics Competition Australian or International Space Design/Settlement Design Competitions Bond University High Schools Mooting Competition National / International Biology, Chemistry or Physics Olympiads or Tournaments National Geographic Channel Australian Geography Competition PWC Australian Economics and Business Studies Competition QAMT or Macquarie Bank Future Problem Solving Competition RACI Australian National Chemistry Quiz or Chemical Analysis Competition Rio Tinto Big Science Competition UNSW ICAS English, Maths or Science Competitions UQ School of Economics QETA Student Economics Competition Please list achievements and year of awards below: e.g ICAS Maths-HD, 2015 RACI HD. Step 7 Leadership In years 11-12, have you held any significant leadership positions and/or participated in any leadership programs? Please see the list below for examples. School captain, vice-captain or house captain Music or debating team captain Sporting team captain or coach Student Representative Council, Interact Club office bearer or similar (e.g. president, secretary or treasurer) Defence Force cadet Emu Gully Leadership Program ADF Long Tan Leadership Teamwork Award TIP Leader Australian Student Leadership conference Please list achievements and year of awards below: e.g School Captain, 2014 ADF Long Tan L Ship.

5 Step 8 Community Service In years 11-12, have you undertaken any significant or ongoing community service activities? Please see the list below for examples. Surf Life Saving club Sony Foundation Children s Holiday camp Rosies Friends on Street Outreach program Camp Quality The Smith Family student2student reading program Kokoda Challenge Scouts Australia Girl Guides Australia Please list activities and year below: e.g Girl Guides, 2014/15 Sony Children s holiday camp Step 9 Awards received in Years In years 11-12, have you received any significant awards? Please see the list below for examples. Duke Of Edinburgh (Gold Award only) Lions Youth Of The Year - State or National finalists only Order Of Australia Association Student Citizenship Award Pierre De Coubertin Award Quest Newspapers Young Star Awards - Category Winner Caltex All-Rounder Please list awards and year received below: e.g. 2014/15 Caltex All-rounder

6 Step 10 Major Youth Forums and Conferences In years 11-12, have you attended any of the following forums or conferences? Please see the list below for examples. QLD or National Youth Aerospace Forum National Mathematics Summer School National Schools Constitutional Convention National Youth Science Forum United Nations Youth Conference Engineering Links Camp UQ Young Scholars Program Global Young Leaders Conference Please list forums or conferences and year attended below: e.g UN Youth Conference, National Youth Science Step 11 Undergraduate Medicine and Health Science Admissions Test (UMAT) Have you completed the Undergraduate Medicine and Health Sciences Admission Test (UMAT)? If you ticked yes, please indicate your results for each component. You will be required to provide evidence. Section 1: Section 2: Section 3: Total UMAT Score: Step 12 UQ Residential College Have you applied for a place at one of The University of Queensland's Residential Colleges? Name of College:

7 Step 13 Educational Disadvantage UQ reserves a number of Academic Scholarships for high-achieving students who have experienced educational disadvantage during their senior studies. Please tick either or both of the following if they apply to you. Significant financial hardship Geographic isolation (i.e. living and studying in an isolated area) If you ticked either of the above, please describe in your Personal Statement how your circumstances have affected you and influenced your ability to achieve academically in years 11 and 12. You will also need to provide evidence of your circumstances. Examples of evidence that should be provided: Significant financial hardship: current Centrelink statements (e.g., Youth Allowance, FTB etc), parents' most recent ATO (income tax) assessment notices, any other documentation that is relevant to your financial circumstances. Geographic isolation: school reports showing name and location of high school. Step 14 Personal Statement Please provide a Personal Statement of no more than 300 words in support of your application. This is an opportunity for you to tell us about your future study and career aspirations including any educational disadvantage if indicated in step 13. Your Personal Statement should be attached to the documentation you provide to the University as part of the application process.

8 Step 15 Applicant Declaration I have read the UQ Academic Scholarship Guidelines. I understand that the scholarship selection process is very competitive and not all applicants who meet the eligibility criteria will be awarded a scholarship. I understand that if I am awarded a named or industry-sponsored Academic Scholarship, that this award will be conditional on enrolling, and remaining enrolled in the program stipulated in my scholarship offer. I give permission for my Year 12 results and relevant information to be provided to UQ through QTAC. If awarded a UQ Academic Scholarship, I give permission for my name, contact and scholarship details to be released to university faculties and divisions, residential colleges and my year 12 high school. I declare that the information supplied on this form is complete and correct to the best of my knowledge. If any information provided is found to be false or misleading, I accept that the University may cancel or withdraw any scholarship awarded to me and require me to repay any scholarship funds received. Date:

Non-Award Study Application and Enrolment Form

Non-Award Study Application and Enrolment Form LODGING YOUR APPLICATION Students should lodge this application with the relevant Faculty Office, at locations listed under the General s and Conditions section