Academic Bursary Application Form

Please complete the application form below.

Before you submit your application please ensure you have completed and included the following:

Eligibility criteria read and met
Completed all questions on the application form
Attached a copy of your academic transcript to your application form

Personal Details

Surname
Given name/s
Primary telephone number
Secondary telephone number
Are you an Australian Citizen or permanent resident?	Yes No
Gender	Male Female
Email Address
Permanent Home Address PO Box not acceptable
Suburb
State
Postcode
Semester Residential Address If different from above
Suburb
State
Postcode

Study Details

University attending
Month/Year of completion
Current degree
Major
Study Enrolment
Cumulative Grade Point Average (GPA)
Attach a copy of your academic transcript with results
Name of secondary school attended

Written Statements

Do you receive an employer linked bursary?	Yes No
If Yes, please detail: Provide a brief statement no longer than 250 words
What are your strengths and what do you believe you can offer the Mackay Region? Provide a brief statement no longer than 250 words
What are your aspirations and goals? Provide a brief statement no longer than 250 words
Are you seeking employment in the Mackay region following completion of university studies and why? Provide a brief statement no longer than 250 words

Student Declaration

In submitting this form, I declare that the information supplied on this form and in the accompanying documents and statements is complete and correct to the best of my knowledge. If any of the information is found to be false or misleading, I accept Mackay Regional Council may cancel any bursary that may be awarded to me on the basis of this application and I may be required to repay any monies obtained.

I agree
I disagree