Scholarship application form

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1 King & Amy O Malley Trust PO Box 120, Camberwell, Vic 3124 Tel: (03) Web: Scholarship application form 1. Use this form to make an application in 2013 for a scholarship in Your application must comprise: o o the original of this Scholarship application form, completed in line with the instructions on the form originals of all the documents required o plus four photocopies of the completed Scholarship application form and all the documents required (please note: if the passport-sized photo did not copy well, attach an original photo to each of the four copies). 3. Please complete this application form in neat, decipherable handwriting. If you are able to enter text directly into this.pdf format file, you may do so. You may also attach extra typed sheets with answers to the points requiring detailed explanations (About your community participation, about your professional activities, about your awards, How your program meets eligibility criteria, about your professional goals) rather than handwriting them. 4. Post your application with the original noted as original plus 4 copies to: King & Amy O Malley Trust PO Box 120 Camberwell Victoria Your application must be received at the Camberwell post office by 5 p.m. on 26 July Please make sure to complete the Scholarship application form completely in accordance with the instructions on the form, correctly and tidily. If your application is incomplete, incorrect or indecipherable, it will not be considered by the Trustees. It is therefore in your interests to pay close attention to the requirements stated on this form. 7. All applications, including supporting documents and referees reports, remain the property of the Managing Trustees and will not be returned to you. 8. You must also: arrange for at least two people to provide written references for you to include with your application; Academic and at least one professional or personal reference provide each referee with a Referee statement form and a Referee information sheet make sure that your referees return the form and attachments to you in time for you to submit your application on or before the closing date note that if you are selected for interview, you should make yourself available whenever possible refer to website for Information for applicants on how to complete the application and for the selection criteria.

2 About you (the applicant) Please provide the information needed to complete each point, and tick the correct option as required. My surname is: My given names are: My address is: My address during term is: My permanent home address is: My preferred address for mail is: my address during term my permanent home address other (please provide address) If selected for interview, please indicate preferred : My daytime phone number is: ( ) My after-hours phone number is: ( ) My mobile phone number is: My date of birth is: My citizenship is: About your study before 2013 Australian Other If you are not an Australian citizen you must provide evidence of your residency (see the note on page 10) Please provide the information needed to complete each point, and complete the table. My highest year level completed of secondary school was: Completed in the year: My other study undertaken and postsecondary qualifications are: Post-secondary qualification Institution Year completed (If this space is insufficient, please provide details on a separate sheet) Other study undertaken Institution Year/s undertaken

3 About your study in 2013 Please provide the information needed to complete each point, and tick the correct option as required. Are you currently studying? Yes No The name of the program I am undertaking is: The year I am in in 2013 is: (e.g. first year) The institution s name is: The institution s address is: About your O'Malley scholarship status Please provide the information needed to complete each point, and tick the correct option as required. Are you a current or past scholarship holder? My surname & given names when I received the scholarship were: Yes No If No, go to About your employment history (If your name is the same, write As above ) I was awarded a full-time / parttime scholarship for the years indicated: Year 1 Full-time Part-time Year 2 Full-time Part-time Year 3 Full-time Part-time About your employment history Please provide details of your past and present employment history. Employer Position Start, finish dates Type F/T P/T Casual F/T P/T Casual F/T P/T Casual F/T P/T Casual F/T P/T Casual How did you hear about the scholarship? Newspaper Website University lecturers University noticeboard Family Friends Professional bodies Other students Trust newsletter Other:

4 About your community participation Please describe, briefly and in your own words, any community or volunteer groups (such as advocacy, sporting, youth, hobby or religious groups) with which you have been involved, and your involvement. About your professional activities Please list and provide brief details (including dates) of any memberships and officerships of professional, student or other associations you hold or have held; any research papers or publications you have authored; presentations you have made; and attendances at conferences. About your awards Please provide brief details (including dates) of education, community or other awards you have gained.

5 About the study for which you seek a scholarship in 2014 I am applying for Full Time undergraduate Full Time post-graduate Part-Time post-graduate Complete: A: Applicants for undergraduate study if you are applying for an undergraduate study scholarship OR B: Applicants for postgraduate study if you are applying for a postgraduate study scholarship AND C: All applicants A: Applicants for undergraduate study Please provide the information needed to complete each point, and tick the correct option as required. The title of the course / program is: The institution offering the program is: The year I started the program is: The year I anticipate completing the program is: I am applying for a scholarship for Year: of the program The name of the program course coordinator / supervisor is: Their title is: Their address is: Their address is: Their telephone number is: ( )

6 B: Applicants for postgraduate study Please provide the information needed to complete each point, and tick the correct option as required. The title of the postgraduate course / program is: The institution offering the program is: The year I started the program is: The year I anticipate completing the program is: I am applying for a scholarship for year: I have: of the program an undergraduate qualification which meets all the program criteria and my postgraduate program meets one or more of those criteria OR an undergraduate qualification which meets one or more of the program criteria and my postgraduate program meets all the criteria Please attach detail of how your past and intended studies make you eligible for a scholarship in line with the above option you have chosen. Please also provide details of your previous qualification and current course of study and attach original transcripts (for the previous qualification) and enrolment statements (for the current course of study). The name of the program course coordinator / supervisor is: Their title is: Their address is: Their address is: Their telephone number is: ( )

7 C: All applicants There are six program eligibility criteria. Please state in your own words how your intended program meets these criteria. About your professional goals Please state in your own words, and in words your professional goals. In your statement, demonstrate your clear intention to work in the Home Economics or equivalent field, and to make a professional contribution to the field. Given your personal philosophy and personal goals, what contribution do you believe you will be able to make to the practice of Home Economics in Australia?

8 About your referees Please provide details for two people who have agreed to provide written references for you. You must provide one Academic reference, plus a personal or professional reference. You must provide each referee with a confidential Referee statement and a Referee information sheet. A: Academic referee Your academic reference must be from a person teaching or supervising you during this year or last year. Post graduate students please note that this reference does not replace the supervisor s progress report required when academic results are not available mid-course. My referee s name is: Their title / position is: Their address is: Their address is: Their phone number is: ( ) B: Personal referee My referee s name is: Their title / position is: Their address is: Their address is: Their phone number is: ( ) C: Professional referee My referee s name is: Their title / position is: Their address is: Their address is: Their phone number is: ( )

9 Items to attach to your application Complete: A: Items for undergraduates if you are applying for an undergraduate study scholarship OR B: Items for postgraduates if you are applying for a postgraduate study scholarship A: Items for undergraduates Please ensure that the following items are attached to each copy of your application. I have attached to this application: B: Items for postgraduates A recent passport size photo of myself A copy of my intended program / course of study outlining the program structure, indicating in which year I will study each subject Original official or downloaded documents detailing: (if you are currently a student) my current enrolment in a study program OR (if you are not currently a student and if available) official notification of my acceptance into an eligible program (if you are a Year 12 student) my Year 11 results OR (if you are a first year undergraduate student) my years 11 & 12 and Semester results OR (if you are a later year undergraduate student) my official undergraduate results to date including Semester (If you are not an Australian citizen) authenticated evidence of my legal residency (see note on page 10) at least two references (one academic reference plus one other) Please ensure that the following items are attached to each copy of your application. I have attached to this application: A recent passport size photo of myself A copy of my intended program / course or study outlining the program structure indicating subjects or research to be taken each year Original official or downloaded documents detailing: (if you are currently a student) my current enrolment in a study program OR (if you are not currently a student and if available) official notification of my acceptance into an eligible program my official undergraduate results any postgraduate results or reports to date including Semester (If you are a postgraduate research student) a progress report from my program supervisor (or make sure your supervisor comments in their academic reference) (If you are not an Australian citizen) authenticated evidence of my legal residency (see note on page 10) at least two references (one academic plus one other)

10 Your attestation Please read the attestation carefully, then date and sign it as evidence that you agree. I accept that the Managing Trustees may, at their absolute discretion, accept or refuse my application for this award and I agree that I shall not make any claim or demand in respect of such application. I accept that the information supplied to the Managing Trustees shall be and remain their absolute property; it may at some time be destroyed and may be provided only to those involved in scholarship selection. (The trust abides by Commonwealth and privacy legislation). I will notify the Managing Trustees if my address or contact telephone number alters before the end of this year. I certify that the information I have supplied is complete and accurate to the best of my knowledge. ATTESTED on the day of 201 (Insert day, month & year) X (Person making the attestation signs here) Original documents and authenticated copies 1. A citizen of another country living in Australia must provide a photocopy of the identification page and the visa page from their passport showing their permanent residency status. The photocopies must be authenticated by an appropriate authority, such as a justice of the peace or member of Victoria Police. For a full list of authorities, see the Department of Justice website at and go to The Justice System, Statutory Declarations. Where the trust requires multiple copies, one copy must be the original or an authenticated signed copy of that original. The remaining copies can be photocopies of the authenticated document 2. Confirmation of enrolment or transcript of results can include the original or a downloaded statement from the university website that will meet Centrelink requirements.

11 King & Amy O Malley Trust PO Box 120, Camberwell, Vic 3124 Tel: (03) Web: Referee statement Thank you for providing this statement and your reference. They will help the Managing Trustees during the selection process for the scholarships. The Referee information sheet provides information about the King & Amy O Malley trust, the scholarship and what is required for a reference. Please read it before completing this form and writing your reference. The confidentiality of your reference is protected under Section 35 of the Victorian Freedom of Information Act Please provide the information required to complete each point and tick the relevant box where required. The applicant's name is: I have known the applicant for: year(s) My name is: My organisation is: My title / position is: My address is: My address is: My phone number is: The nature of this referee statement is: I have: academic reference AND personal reference OR professional reference read the attached Referee information sheet attached my assessment of the applicant, in line with the guidance provided in the Referee information sheet (Write day, month & year) (Sign here) X Please return this form and reference to the applicant as soon as possible.

12 Referee information sheet NB 1 Applicants may not act as a referee for other applicants within the same year and state. King & Amy O Malley Trust PO Box 120, Camberwell, Vic 3124 Tel: (03) Web: NB 2 assessment panel members may not act as a referee for applicants within their state while being a panel member. King O'Malley was a member of the first Federal Parliament. During his twenty year career as a politician, he played an important role in the development of modern Australia, including the foundation of Canberra, the construction of the transcontinental railway and the establishment of the Commonwealth Bank. King and Amy O'Malley believed that Australian family life should be strengthened and supported for the sake of the nation. Having no living relatives, they decided to establish a trust fund that would accrue interest for twenty one years, after which the interest would be used for Home Economics scholarships. Up to 30 scholarships are awarded across Australia each year, for study in the following year in a Home Economics or equivalent program (including teaching, community services, food and nutrition, public health, family and consumer studies, textiles and housing). Scholarships are not awarded to people intending to prepare for careers in manufacturing, trading, catering or entertainment fields, or for courses at trade schools. We select applicants for interview on the basis of their application and references. The current value of the scholarships is available from the trust s website, at Successful applicants are expected to achieve high academic standards, to make a positive contribution to the profession and to undertake leadership roles. About your reference The applicant will have asked you to make either an academic reference, a personal reference, or a professional reference. Your reference should be a statement in your own words about how effectively the applicant meets the applicant criteria relevant for your type of reference. Specifically: an academic reference should assess the academic potential of the applicant. You must have taught or supervised the applicant this year or last year a professional reference should assess the capacity of the applicant to make a significant contribution in Home Economics or a related area in the future a personal reference should assess the personal attributes of the applicant. Please indicate for how long you have known the applicant. The table below shows the applicant criteria. Professional goals Academic potential Personal attributes Clear career intentions to work in an educative and advocacy role for families and households The potential to work in a leadership role and make a professional contribution to fields related to Home Economics Broad and deep knowledge about Home Economics and its role in society A current involvement in Home Economics or related professional associations High grades, normally having passed all subjects at the first attempt A capacity for critical and analytical thinking The potential to succeed academically at a high level The persistence and motivation to achieve Integrity, maturity and leadership qualities, well-developed communication skills An ethic of service A commitment to inclusivity and social justice Sensitivity in dealing with a range of people and issues, the ability to work collaboratively

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