2016 IYDP Application Form
Indigenous Youth Development Program 2016 Secondary Scholarship Years 7-11
An initiative of the Townsville Catholic Education Office, funded by the Department of Prime Minister and Cabinet STUDENT APPLICATION FORM Student Applicant’s Full Name:
__________________________________________________________
Which school are you currently attending? __________________________________________________________
☐ Male
Gender: Address
☐ Female
________________________________________________________________________________ ________________________________________________________________________________ State: ________________
Post Code: ___________________________________
Home community (if different to you above Address): ___________________________________________________________ Home Phone: ____________________
Mobile: ____________________________________________________
Email Address: __________________________________________________________________________________ Date of Birth: ______________
Age: _____________
Does the student identify as Aboriginal or Torres Strait Islander*? If “yes”, please tick below
☐ ☐
☐Yes ☐No
Aboriginal ☐ Torres Strait Islander Both Aboriginal and Torres Strait Islander
*If successful, evidence of Aboriginality or Torres Strait Islander Descent will be required
Do you speak a language other than English?
Yes
No
(Please provide language name)
Aboriginal Language Torres Strait Islander Language Aboriginal English Broken English Torres Strait Creole/ Yumpla Tok The Dept. of Prime Minister and Cabinet (PMC) can only guarantee funding until 2017. Therefore, Townsville Catholic Education can only offer a two years and one semester scholarship – Start Term 4 Semester 2, 2015 finish end of 2017 In administering the Indigenous Youth Development Program (IYDP), Townsville Catholic Education Office (TCEO) will need to collect personal information from you. This will include the personal information provided on this form and may also include other personal information collected by the educational institution attended by you if you are successful with your application. The purpose of these collections is to enable TCEO to administer the IYDP and will not be used for other purposes, except as authorised or required by law. TCEO is also required to provide some of your personal information contained on this form to the Dept. of Prime Minister and Cabinet (PMC). This will be used by PMC for program monitoring and evaluation purposes. PMC will not use or disclose your personal information for any other purpose except as authorised or required by law.
Student Questions Questions Students requiring assistance completing this form may contact Indigenous Education 07 4773 0952 1.
What scholarship are you applying for?
☐ The Arts 2.
☐ Sport
☐ Academic
What do you hope to achieve (for example your aspirations and dreams)? _______________________________________________________________________________________ _______________________________________________________________________________________
3.
Where do you feel you need support to achieve your aspirations and dreams? _______________________________________________________________________________________ _______________________________________________________________________________________
4.
Can you name three positive qualities that describe you? _______________________________________________________________________________________ _______________________________________________________________________________________
5.
Have you received any school or sports awards, trophies or certificates? What were they for? _______________________________________________________________________________________ _______________________________________________________________________________________
6.
What community or school activities have you been involved in? _______________________________________________________________________________________ _______________________________________________________________________________________
7.
What career opportunities are you working towards when you finish school? _______________________________________________________________________________________ _______________________________________________________________________________________
8.
Are you receiving another grant or scholarship? If yes, please give details: _______________________________________________________________________________________ _______________________________________________________________________________________
9.
Are you currently completing an Apprenticeship or Traineeship? If yes, please give details: Name of the employer:
____________________________________
Name of Course:
____________________________________
Year started:
_______________
Is there any other information that you would like us to take into consideration? _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
Please sign and date: Applicant’s Signature: _______________________________________________ Applicant’s Name:
_______________________________________________
Date:
________/___________/_________
2016 Indigenous Youth Development Program Program Parents or caregivers requiring assistance completing this form may contact Indigenous Education 07 4773 0952 PARENT / GUARDIAN APPLICATION FORM Student Applicant’s Full Name:
__________________________________________________________
Parent/Guardian/Caregiver Full Name:
__________________________________________________________
Partners (Husband/Wife/Defacto) name:
__________________________________________________________
Relationship to Student Applicant:
__________________________________________________________
Gender:
☐
Address
Male
☐
Female
________________________________________________________________________________ ________________________________________________________________________________ State: ________________
Post Code: ___________________________________
Home community (if different to you above Address): ___________________________________________________________ Home Phone: ____________________
Mobile: ____________________________________________________
Email Address: __________________________________________________________________________________ Do you identify as Aboriginal or Torres Strait Islander*? If “yes”, please tick below
☐ ☐
☐Yes ☐No
Aboriginal ☐ Torres Strait Islander Both Aboriginal and Torres Strait Islander
Do you speak a language other than English?
Yes
No
(Please provide language name)
Aboriginal Language Torres Strait Islander Language Aboriginal English Broken English Torres Strait Creole/ Yumpla Tok Are you employed? _________________
Full time or part-time? ____________________
Where do you work? _________________________________________________________ Is the Applicant eligible for Abstudy assistance?* ☐Yes ☐No *If successful, you will be required to provide a copy of Abstudy documentation from Centrelink
Parent /Guardian /Guardian Questions Questions Parents or Guardians requiring assistance completing this form may contact Indigenous Education 07 4773 0952 1.
What Catholic College is your child currently enrolled at? _______________________________________________________________________________________ _______________________________________________________________________________________
2.
How many other children are in your family/care? Please state their ages. _______________________________________________________________________________________ _______________________________________________________________________________________
3.
Do any of your children receive a scholarship or education program (past or present)? If yes, please state their name and name of the scholarship or education program. _______________________________________________________________________________________ _______________________________________________________________________________________
4.
How will you encourage your child to stay at school and complete Yr 12? _______________________________________________________________________________________ _______________________________________________________________________________________
5.
Attendance is part of the IYDP Scholarship requirement. How will you support your child to attend school each day every school Term. _______________________________________________________________________________________ _______________________________________________________________________________________
6.
Is there any other information that you would like us to take into consideration in regards to your child, yourself and your family? _______________________________________________________________________________________ _______________________________________________________________________________________
Parent/ Guardian: I give my consent for _______ to apply for an IYDP Secondary Scholarship with Townsville Catholic Education. I understand that if selected for an IYDP Secondary Scholarship, they will be required to attend an IYDP Education Provider that is in partnership with Townsville Catholic Education. I also give my permission to Townsville Catholic Education and PMC to publish photos that maybe taken of my son/daughter to be used in the Media or on their official website. Parent/Guardian Signature: ___________________________________________________ Parent name: __________________________________________________ Date: ____ / /
2016 Indigenous Youth Development Program Please ask a non-family member to complete
RERFERENCE FORM
Applicant’s Name: Referee’s Name: Referee’s Street Address: Primary Contact Phone:
Mobile:
Secondary Contact Phone:
Fax:
Email Address: Occupation/ Position:
Please answer the following questions: What is your relationship to the applicant?____________________________________________________ How long have you known the applicant?_____________________________________________________ Explain why you believe the applicant should receive an IYDP Secondary School Scholarship? _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Signed ______________________ Date
______________________
2016 Indigenous Youth Development Program Program IMPORTANT PLEASE NOTE Your application WILL NOT BE CONSIDERED if you do not provide ALL of the following information:
Parent application
Student application
Most recent school reports
One written reference th
The closing date is 7 August 2015. Late or incomplete submissions will not be considered. Applicants should submit their applications as early as possible, prior to the closing date if possible. Please submit ONE copy of your application by one of the delivery methods listed below: By post: Please address it as: IYDP (Private & Confidential) Townsville Catholic Education –Indigenous Education Services PO Box 861 Aitkenvale QLD 4814 By email:
[email protected]
By Fax:
(07) 4773 0901
An initiative of the Townsville Catholic Education Office, funded by the Department of Prime Minister and Cabinet STUDENT APPLICATION FORM Student Applicant’s Full Name:
__________________________________________________________
Which school are you currently attending? __________________________________________________________
☐ Male
Gender: Address
☐ Female
________________________________________________________________________________ ________________________________________________________________________________ State: ________________
Post Code: ___________________________________
Home community (if different to you above Address): ___________________________________________________________ Home Phone: ____________________
Mobile: ____________________________________________________
Email Address: __________________________________________________________________________________ Date of Birth: ______________
Age: _____________
Does the student identify as Aboriginal or Torres Strait Islander*? If “yes”, please tick below
☐ ☐
☐Yes ☐No
Aboriginal ☐ Torres Strait Islander Both Aboriginal and Torres Strait Islander
*If successful, evidence of Aboriginality or Torres Strait Islander Descent will be required
Do you speak a language other than English?
Yes
No
(Please provide language name)
Aboriginal Language Torres Strait Islander Language Aboriginal English Broken English Torres Strait Creole/ Yumpla Tok The Dept. of Prime Minister and Cabinet (PMC) can only guarantee funding until 2017. Therefore, Townsville Catholic Education can only offer a two years and one semester scholarship – Start Term 4 Semester 2, 2015 finish end of 2017 In administering the Indigenous Youth Development Program (IYDP), Townsville Catholic Education Office (TCEO) will need to collect personal information from you. This will include the personal information provided on this form and may also include other personal information collected by the educational institution attended by you if you are successful with your application. The purpose of these collections is to enable TCEO to administer the IYDP and will not be used for other purposes, except as authorised or required by law. TCEO is also required to provide some of your personal information contained on this form to the Dept. of Prime Minister and Cabinet (PMC). This will be used by PMC for program monitoring and evaluation purposes. PMC will not use or disclose your personal information for any other purpose except as authorised or required by law.
Student Questions Questions Students requiring assistance completing this form may contact Indigenous Education 07 4773 0952 1.
What scholarship are you applying for?
☐ The Arts 2.
☐ Sport
☐ Academic
What do you hope to achieve (for example your aspirations and dreams)? _______________________________________________________________________________________ _______________________________________________________________________________________
3.
Where do you feel you need support to achieve your aspirations and dreams? _______________________________________________________________________________________ _______________________________________________________________________________________
4.
Can you name three positive qualities that describe you? _______________________________________________________________________________________ _______________________________________________________________________________________
5.
Have you received any school or sports awards, trophies or certificates? What were they for? _______________________________________________________________________________________ _______________________________________________________________________________________
6.
What community or school activities have you been involved in? _______________________________________________________________________________________ _______________________________________________________________________________________
7.
What career opportunities are you working towards when you finish school? _______________________________________________________________________________________ _______________________________________________________________________________________
8.
Are you receiving another grant or scholarship? If yes, please give details: _______________________________________________________________________________________ _______________________________________________________________________________________
9.
Are you currently completing an Apprenticeship or Traineeship? If yes, please give details: Name of the employer:
____________________________________
Name of Course:
____________________________________
Year started:
_______________
Is there any other information that you would like us to take into consideration? _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________
Please sign and date: Applicant’s Signature: _______________________________________________ Applicant’s Name:
_______________________________________________
Date:
________/___________/_________
2016 Indigenous Youth Development Program Program Parents or caregivers requiring assistance completing this form may contact Indigenous Education 07 4773 0952 PARENT / GUARDIAN APPLICATION FORM Student Applicant’s Full Name:
__________________________________________________________
Parent/Guardian/Caregiver Full Name:
__________________________________________________________
Partners (Husband/Wife/Defacto) name:
__________________________________________________________
Relationship to Student Applicant:
__________________________________________________________
Gender:
☐
Address
Male
☐
Female
________________________________________________________________________________ ________________________________________________________________________________ State: ________________
Post Code: ___________________________________
Home community (if different to you above Address): ___________________________________________________________ Home Phone: ____________________
Mobile: ____________________________________________________
Email Address: __________________________________________________________________________________ Do you identify as Aboriginal or Torres Strait Islander*? If “yes”, please tick below
☐ ☐
☐Yes ☐No
Aboriginal ☐ Torres Strait Islander Both Aboriginal and Torres Strait Islander
Do you speak a language other than English?
Yes
No
(Please provide language name)
Aboriginal Language Torres Strait Islander Language Aboriginal English Broken English Torres Strait Creole/ Yumpla Tok Are you employed? _________________
Full time or part-time? ____________________
Where do you work? _________________________________________________________ Is the Applicant eligible for Abstudy assistance?* ☐Yes ☐No *If successful, you will be required to provide a copy of Abstudy documentation from Centrelink
Parent /Guardian /Guardian Questions Questions Parents or Guardians requiring assistance completing this form may contact Indigenous Education 07 4773 0952 1.
What Catholic College is your child currently enrolled at? _______________________________________________________________________________________ _______________________________________________________________________________________
2.
How many other children are in your family/care? Please state their ages. _______________________________________________________________________________________ _______________________________________________________________________________________
3.
Do any of your children receive a scholarship or education program (past or present)? If yes, please state their name and name of the scholarship or education program. _______________________________________________________________________________________ _______________________________________________________________________________________
4.
How will you encourage your child to stay at school and complete Yr 12? _______________________________________________________________________________________ _______________________________________________________________________________________
5.
Attendance is part of the IYDP Scholarship requirement. How will you support your child to attend school each day every school Term. _______________________________________________________________________________________ _______________________________________________________________________________________
6.
Is there any other information that you would like us to take into consideration in regards to your child, yourself and your family? _______________________________________________________________________________________ _______________________________________________________________________________________
Parent/ Guardian: I give my consent for _______ to apply for an IYDP Secondary Scholarship with Townsville Catholic Education. I understand that if selected for an IYDP Secondary Scholarship, they will be required to attend an IYDP Education Provider that is in partnership with Townsville Catholic Education. I also give my permission to Townsville Catholic Education and PMC to publish photos that maybe taken of my son/daughter to be used in the Media or on their official website. Parent/Guardian Signature: ___________________________________________________ Parent name: __________________________________________________ Date: ____ / /
2016 Indigenous Youth Development Program Please ask a non-family member to complete
RERFERENCE FORM
Applicant’s Name: Referee’s Name: Referee’s Street Address: Primary Contact Phone:
Mobile:
Secondary Contact Phone:
Fax:
Email Address: Occupation/ Position:
Please answer the following questions: What is your relationship to the applicant?____________________________________________________ How long have you known the applicant?_____________________________________________________ Explain why you believe the applicant should receive an IYDP Secondary School Scholarship? _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Signed ______________________ Date
______________________
2016 Indigenous Youth Development Program Program IMPORTANT PLEASE NOTE Your application WILL NOT BE CONSIDERED if you do not provide ALL of the following information:
Parent application
Student application
Most recent school reports
One written reference th
The closing date is 7 August 2015. Late or incomplete submissions will not be considered. Applicants should submit their applications as early as possible, prior to the closing date if possible. Please submit ONE copy of your application by one of the delivery methods listed below: By post: Please address it as: IYDP (Private & Confidential) Townsville Catholic Education –Indigenous Education Services PO Box 861 Aitkenvale QLD 4814 By email:
[email protected]
By Fax:
(07) 4773 0901
