Education Support Program Application Form
HEAD TENANT / HOUSEHOLD DETAILS
Application Date
-
Day
-
Month
Year
Date
First Name
*
Last Name
*
Address
*
DOB
*
-
Day
-
Month
Year
Date
Age
*
Gender
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Eligibility Criteria Note: All criteria must be met to be eligible for an Education Scholarship
*
I have been a Pacific Link tenant or household member for more than 6 months
I am an Australian citizen or permanent resident
My rent payments and non-rent payments are up to date
The applicant/student is currently enrolled in studies and can provide proof of enrolment
The applicant/student has not received an Education Scholarship in the past 3 years
Are you of Aboriginal or Torres Strait Islander origin?
Yes
No
Do you speak a language other than English at home?
Yes
No
If Yes please specify
Do you have a disability or ongoing medical condition?
Yes
No
If Yes please specify
Back
Next
APPLICANT / STUDENT DETAILS
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Age
*
Gender
*
Is the applicant of Aboriginal or Torres Strait Islander origin?
Yes
No
Does the applicant have a disability or ongoing medical condition?
Yes
no
Prefer not to say
Comments
Back
Next
APPLICATION INFORMATION
What level of education are you currently studying?
*
Primary School
High School
Tertiary Studies (TAFE, College, Uni)
What items would you like from the Education Scholarship?
*
Laptop
Other
please provide detailed information and cost - invoices/quotes can be uploaded in the following question
Please upload any invoices or quotes for specific items if relevant
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Why do you want the Education Scholarship?
*
How will the Education Scholarship help with your studies?
*
Would you like to mention any special circumstances?
Back
Next
SCHOOL DETAILS
School Grade
*
School Grade
School Name
*
School Address
*
Back
Next
TERTIARY EDUCATION DETAILS
Course enrolled in
*
Institution e.g. TAFE, Uni, College
*
Campus Address
*
What level of tertiary studies are you currently in?
*
Cert 1
Cert 2
Cert 3
Cert 4
Diploma or higher
What is your current employment status?
*
Full-time employment (at least 38 hrs per week)
Part-time employment (fewer than 38 hrs per week)
Self-employed
Casual worker (at least 38 hrs per week)
Casual worker (fewer than 38 hrs per week)
Student
Unemployed i.e. actively looking for work
Unemployed due to an injury, illness or disability
Other
Compared to the average Australian, how would you rate your mathematical skills?
*
Needs improvement
1
2
3
4
5
6
7
8
9
excellent
10
1 is Needs improvement, 10 is excellent
Do you agree that your level of computer skills meets your present needs?
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agrees
7
1 is Strongly Disagree, 7 is Strongly Agrees
Do you agree that you are in control of your life?
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agrees
7
1 is Strongly Disagree, 7 is Strongly Agrees
Please upload proof of enrolment in tertiary education
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Back
Next
APPLICATION DECLARATION
Full name of person making this declaration (If student is under the age of 16, this declaration should be completed by a parent or guardian)
*
Certify that the personal information provided in this application is correct
*
Yes
I give permission for Pacific Link to collect, use and disclose personal details only forthe purpose of assessing the application and administering funds?
*
Yes
I give permission for Pacific Link to use my / my child's success story and photograph for publicity purposes in annual reports, newsletters, social media, website etc.
*
Yes
No
I would like my / my child's name changed in any publicity communications.
*
Yes, please change name
No, you can use my first name
How did you find out about the Education Scholarship program?
Website
Newsletter
Staff Member
Email
Other
Please specify
Submit
Should be Empty: