Tertiary Education Bursaries Application | Iwasaki Foundation Central Queensland

Section A - Personal Details

Surame * Given Names * Date of Birth * Telephone * Mobile Phone Email Address * Address * Preferred format for correspondence * Are you an Australian citizen or permanent resident? * Applicant Photo *

I have read and understand the Bursary Application Guidelines relating to this application.

Section B – Proposed Course Details

Name of course(s) for which you are applying:

Course 1 * Course 2

Name of institution(s) where you wish to study:

Preference may be given to students attending Central Queensland tertiary institutions.

Institution 1 * Institution 2 *

Name of course(s) for which you are applying:

Course 1 * Course 2 *

If part-time, please provide details

Please submit a photocopy of any documents as proof of your intention to enrol in a course OR A letter of offer into a course. *

Section C – Most Recent Academic results

Place of Study * Year of Study * Certificate or Course? *

Subject 1 * Subject 1 Result * Subject 2 Subject 2 Result Subject 3 Subject 3 Result Subject 4 Subject 4 Result Subject 5 Subject 5 Result

Please submit a copy of your academic results from your education provider:

Current Year 12 students

The due date for my Year 12 results is:

Section D – Personal statement

This is your opportunity to make your case to the Bursary Sub-committee. Your statement should be no longer than 500 words and include information about yourself, your future goals and the impact your needs or disability has had on your study and career choice. Please also outline the barriers you have faced, or may face, in purchasing adaptive technology? Your statement should also demonstrate your potential for success in higher education and may include past academic results, employment history, participation in study groups or other training, community service, leadership roles, and other achievements.

Insert your personal statement below:

Section E – Letter from a Referee

A referee may be a representative from your school, local community group or a person who has known you for at least 12 months.

The letter must refer to Iwasaki Foundation Tertiary Education Bursary and should include information about your need for the Bursary and your ability to achieve in your chosen education option.

The letter can be submitted with this application or sent separately from the referee’s email address to info@iwasakifoundation.com.au.

It is preferable if the referee letter is submitted on letterhead.

Name of Referee: * Reference was emailed directly: * Reference was submitted with this application: *

Attach Reference Letter

Section F: Financial Assessment

Please note that many tertiary institutions offer a range of grants or scholarships varying from $500 to $20,000, which can support the academic costs of tertiary studies.

1. Have you applied, or do you intend to apply for any academic grants or scholarships? *

If yes, please state the value, purpose and funding source

Value: Purpose: Funding Source If successful, please explain why you would still require funds from the Bursary:

All questions must be answered

2. Do you receive, or will you receive during your intended course, income from any of the following sources?

Full time paid employment * Amount Per Annum

Part time paid employment * Amount Per Annum

Disability Support Pension (Blind) * Amount Per Annum

Disability Support Pension * Amount Per Annum

Austudy * Amount Per Annum

Austudy Pensioner Education Supplement * Amount Per Annum

Abstudy * Amount Per Annum

Newstart * Amount Per Annum

Youth Allowance * Amount Per Annum

Other (If Yes, Please Specify) * Amount Per Annum Source

3. Please supply the following financial details:

Details of nett taxable income of your parents, spouse/partner for the last financial year: * If there have been any significant changes in that income since that date, details of those changes: * Will you receive financial support from your parents, spouse/partner or any other source?: *

4. List your current financial commitments and any additional costs that you expect to incur throughout your course (e.g., additional equipment, accommodation, travel costs, childcare costs, medical costs or up-front fees).

Current Financial Commitment: * Future Additional costs: * How will these affect your ability to purchase the adaptive technology necessary for your studies? *

Section G: Additional Uploads

I CONSENT to Iwasaki Foundation using my photograph (whether singly or in a group) and details of the University course I undertook and the results I achieved provided this information is used only for publicity purposes that may benefit Iwasaki Foundation.

Date

Tertiary Education Bursaries Online Application

Apply Online

Section A - Personal Details

Section B – Proposed Course Details

Name of course(s) for which you are applying:

Name of institution(s) where you wish to study:

Name of course(s) for which you are applying:

If part-time, please provide details

Section C – Most Recent Academic results

Current Year 12 students

Section D – Personal statement

Section E – Letter from a Referee

Section F: Financial Assessment

1. Have you applied, or do you intend to apply for any academic grants or scholarships? *

2. Do you receive, or will you receive during your intended course, income from any of the following sources?

3. Please supply the following financial details:

4. List your current financial commitments and any additional costs that you expect to incur throughout your course (e.g., additional equipment, accommodation, travel costs, childcare costs, medical costs or up-front fees).

Section G: Additional Uploads