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Student Financial Support Office Student Support, Murdoch University Telephone: 08 9360 2733Email: scholarships@murdoch.edu.au

1. This Completed Form

2. A Personal Statement

3. Proof of your Academic Achievement(only if your prior studies were not at Murdoch)

4. A Written Academic Reference

The Scholarship for Scientific Excellence acknowledges and rewards commencing students in the College of Science, Health, Engineering and Education (SHEE) within the disciplines of Engineering and Information Technology who have a proven record of high academic achievement in previous studies, and a pursuit for scientific excellence. For further information regarding the eligibility and payment information please see the relevant scholarship page, available on our website.

Scholarship for Scientific Excellence Domestic and International - Postgraduate

PERSONAL DETAILS

Full time (9 points or more)

Part time (6 points or less)

Given Name: Surname:

Date of Birth: Contact Number: Email Address:

Murdoch Student Number (8 digits):

Degree Title & Major: Year of Study:

Study load:Student Type:

If you selected Part-time (6 points or less) please complete this section. Please outline the exceptional circumstances that require you to study part-time

Please outline the exceptional circumstances and attach supporting documentation to the application.

Disability and/or medical condition

Significant carer/family responsibilities

Other

CHECKLISTPlease ensure all relevant documents are attached with your application on submission. Please tick the box to indicate the relevant documents are submitted with this application:

WHAT HAPPENS NEXT- Applications are assessed using the information included in your application, and supporting documents.- Murdoch University reserves the right to not award scholarships if there are no suitable applicants.- The Student Financial Support Office receives many more applications each semester than there are scholarships to award, as such scholarships are awarded to the students who are most in need. Should your application be unsuccessful you will be notified via email.

If successfully awarded:- Payments to successful applicants will be made during the weeks that follow the census date in line with the Standard Academic

Calendar- Please be aware that all scholarship payments are processed at the same time, and as such we appreciate your patience during

the busy period.

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PERSONAL STATEMENT - 500 WORDS maximumYour personal statement enables you to provide further details regarding your academic achievements, reasons for applying for the scholarship, and reason for your studying your chosen field.Please attach a personal statement of no more than 500 words that addresses the following: a. What has influenced your decision to study your chosen course? b. What are your personal and career goals? c. How will this scholarship assist you in achieving your personal and career goals? ACADEMIC HISTORYPlease attach a copy of your most recent academic results that demonstrates your high academic achievement and scientific excellence.This may include: ATAR result; evidence of scientific excellence; research publication; or other academic evidence. Please be aware that we can only accept Official Academic Transcripts, not e-records. WRITTEN REFERENCEPlease attrach a WRITTEN reference. The WRITTEN reference should be by a current or former employer or alternatively from an academic staff member that will serve as an academic reference. Please ensure your referees provide their contact details. Alternatively, your referees are welcome to email the Student Financial Support Office directly at: scholarships@murdoch.edu.au

TERMS AND CONDITIONSAs a successful recipient of a Scholarship for Scientific Excellence, I agree to the following terms and conditions and understand that it

is my responsibility to adhere to these conditions:

1. I must remain enrolled in a full-time, internal academic program offered by the School of Engineering and Information Technology at Murdoch University for the full duration of my scholarship, unless granted an exception for exceptional circumstances.

2. I must seek independent advice from the relevant authorities on the effect, if any, that the scholarship may have on my eligibility for income support; or any tax implications.

3. I must notify the Student Financial Support Office (SFSO) in writing immediately if I:

a. Wish to transfer to another academic program within the University.b. Wish to study abroad on a Murdoch University affiliated placement.c. Wish to transfer to another institution.d. Seek a retrospective withdrawal from any units I have enrolled in.e. Choose to defer my studies and/or apply for Approved Leave.f. Discontinue full-time study.

4. I understand that I will forfeit the Scholarship if I:

a. Terminate my enrolment.b. Transfer to another major, course and/or institution, outside the School of Engineering and Information Technology.c. Transfer from full-time to part-time study (unless I have been granted an exemption).d. Do not maintain Satisfactory Academic Progress (see Coursework Regulation 1.34).e. Fail to provide up to date contact and/or financial details to the SFSO when requested.

5. I agree and acknowledge that changes in my enrolment may make me ineligible to receive scholarship payments. In the case that I am deemed ineligible I may be placed on a breached status which would provide an opportunity for to improve my eligibility in the subsequent semester. This opportunity would occur only once for the duration of the scholarship, and is at the discretion of the SFSO.

6. I understand that continuing to receive payments that I am ineligible for will result in action taken by the university. In the case of receiving ineligible funds, I will be required to repay all ineligible payments to the SFSO within a 3 month period.

By ticking and inserting my name in the space provided below, I agree that this constitutes effective execution and agreement to both the terms and conditions, centrelink authorisation statement, and declaration of this form.

Tick: Full name: Date:

I declare that:

- The information I have provided is true and correct.- I understand that providing false or misleading information will result in the cancellation of, and repayment of, my scholarship; and that I will be subject to the provisions of the Student Discipline statute.

DECLARATION & ACCEPTANCE