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APPLICATION FORM

Monash International Leadership Scholarship and Monash International Merit Scholarship
   The eligibility and selection criteria of these scholarships is available on the website http://www.monash.edu.au/international-scholarships You must provide responses to all questions on this form. Do not submit or attach additional documentation to this application form. You will be assessed based on your academic results as well as your personal statement and your potential to be a Monash ambassador

APPLICANT DETAILS: Title:
Mr Mrs Ms Other: Date of Birth: Miss Surname: Given Name(s):

Correspondence Address:

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/

Permanent Home Address (if same as correspondence address print ‘as above’):

Email:

Telephone (pref):

Telephone:

Facsimile: Yes No

Are you currently enrolled at Monash University? If Yes, please provide student number below: Note: This form is to apply for the scholarship only and will not be considered for admission. To apply for admission into a course please go to: Undergraduate - www.monash.edu.au/study/international/apply/undergraduate Postgraduate – www.monash.edu.au/study/international/apply/postgraduate Student Number:

Note: You will not be eligible for this scholarship if you are an Australian or NZ citizen or permanent resident of Australia.

COURSE DETAILS:
Course Name: Course Code: Intake: (eg Sem 1, 2013)

I understand that if I am not offered a Monash International Leadership scholarship, I may be considered for the Monash International Merit Scholarship. I will be notified If I am not successful in obtaining either scholarship.

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please provide details (include name of scholarship. amount and other details) : Yes No How long did you receive this award? __________________________ Are you currently receiving any other awards/scholarships? If YES. PRIVACY AND STUDENT DECLARATION General privacy statement The information collected on this form is used to assess your application for entry to a Monash University course. it may not be possible to process your application. amount and other details) : Yes No When is this award/scholarship due to expire? __________________________ To be eligible to accept the Monash International Leadership Scholarship or Monash International Merit Scholarship. you must not be the recipient of any other scholarship grants or financial incentives funded by Monash University or be sponsored by other bodies/institutions. awarding body. and it 2 . relevant bodies for the verification of your previous qualifications. If you do not complete all the questions on this form. Personal information may be collected from. please provide details (include name of scholarship. awarding body. or disclosed to. It is also used to create an enrolment record on the student database. to prepare a statistical analysis and to inform you about your course and other University courses/events.I understand that if I am not eligible for a course at Monash I will not be eligible for a scholarship I understand that I will not be considered for a scholarship until my course application into the university has been received and processed for an offer Proposal Statement: Please outline the reasons why Monash should award the scholarship to you and your potential to be a Monash ambassador ( 500 words) This can include your personal and academic achievements to date and details of previous community participation or leadership roles OTHER SCHOLARSHIPS Have you previously have received Australian Government-funded award /scholarship? If YES.

including academic transcript/s.edu. I have read and understood the above conditions and accept them fully.edu 3 . I understand that should the information be shown to be false at any stage. or provided in support of my application. we are unable to disclose information to any other third parties such as friends.au/study/scholarships/international/ I warrant that the information on this form.monash. Privacy legislation only applies to students who study in Australia. You have the right to access personal information that Monash University holds about you.au/international-scholarships (same closing dates for both scholarships) Send your completed applications and associated documentation to: International Recruitment Services Monash University 871 Dandenong Rd Caulfield East 3145 Victoria. might invalidate my application and that the University may withdraw an offer of a place or cancel my enrolment in consequence. Signature of applicant: Date: / / Application closing dates: refer to the website http://www. Due to privacy regulations. is correct and complete.monash. I consent to any educational institution at which I have previously been a student and/or my current or any past employer. Should the University determine that I have submitted a false document. the scholarship/bursary will be terminated immediately and I will be liable to re-pay the University the total sum of any payments already made.edu. I agree to abide by the statutes. I acknowledge that the provision of incorrect information or the withholding of relevant information relating to my application.may be disclosed to government agencies. as required by legislation (or pursuant to obligations under the ESOS Act 2000 and the 2007 National Code of Practice or for your visa application should you decide to complete part of your Monash masters in Australia).edu. DECLARATION I have read and understood the scholarship information provided by the University on the Coursework Scholarships and Bursaries web page http://www. Australia Email: ADM-Documents@monash. by contacting the Monash University privacy officer at privacyofficer@monash. I understand that the Coursework Scholarships Unit may disclose the details of my application for selection purposes or details of the scholarships I may be awarded to other areas of the University. I consent to the University disclosing the information to other relevant tertiary institutions. subject to legislation. relatives and parents. Information may be shared with the registered agent you appoint to assist with your application for entry or visa processing if applicable. providing Monash University with information which that institution or employer holds about me for the purpose of Monash verifying my grades and/or qualifications or experience. regulations and policies of Monash University.