2017 APPLICATION FORM

Monash International Leadership Scholarship and

Monash International Merit Scholarship

 The eligibility and selection criteria of these scholarships are available on the website http://www.study.monash/fees-
scholarships/scholarships/find/international-student-scholarships
 You must answer all the questions on this form. Do not submit or attach additional documentation to your application.
 You will be assessed based on your academic results as well as your personal statement about your potential to be a
Monash Ambassador
 You MUST have received a full and unconditional course offer before you apply for these scholarships. Do not submit this
application form if you do not have your Monash Student ID number.

APPLICANT DETAILS:

Monash Student ID Number:

Title: Mr Ms Miss Surname: Given Name(s):

Mrs Other:

Correspondence Address: Date of Birth: / /

Permanent Home Address (if same as Email:

correspondence address print ‘as above’):

Telephone (pref): Telephone: Facsimile:

Applicant nationality:
Agent details:

Are you currently enrolled at Monash University? Yes No

Note: This form is to apply for the scholarship only. To apply for admission into a course go to:

Undergraduate - www.monash.edu.au/study/international/apply/undergraduate

Postgraduate – www.monash.edu.au/study/international/apply/postgraduate

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, 2017)

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.
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 for Monash University has been received
and I have received a full and unconditional offer.

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Proposal Statement:

Scholarships are awarded to highly ranked students who can demonstrate their potential to be an exceptional Ambassador for
Monash.
Outline the details of your future aspirations and how your Monash degree will help you achieve your vision. You can explain how
previous leadership roles or community activities have informed this vision. This statement should not focus on your academic
achievements or the financial benefit of the scholarship.
Your statement must be typed in the space below and should not exceed 500 words.

OTHER SCHOLARSHIPS

Have you previously have received Australian Government-funded award /scholarship? Yes No

If YES, please provide details (include name of scholarship, awarding body, amount and other details):

How long did you receive this award? __________________________

Are you currently receiving any other awards/scholarships? Yes No

If YES, please provide details (include name of scholarship, awarding body, amount and other details):

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.

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 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 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. If you do not complete all the questions on this form, it may not be possible to process your application.
Personal information may be collected from, or disclosed to, relevant bodies for the verification of your previous qualifications, and
it 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). Information may be shared with the registered agent you appoint to assist with your application for entry or visa
processing if applicable. You have the right to access personal information that Monash University holds about you, subject to
legislation, by contacting the Monash University privacy officer at privacyofficer@monash.edu. Privacy legislation only applies to
students who study in Australia.

Due to privacy regulations, we are unable to disclose information to any other third parties such as friends, relatives and parents.

DECLARATION

I have read and understood the scholarship information provided by the University on the Coursework Scholarships web page
/www.study.monash/fees-scholarships/scholarships/find/international-student-scholarships
I warrant that the information on this form, or provided in support of my application, is correct and complete. I acknowledge that the
provision of incorrect information or the withholding of relevant information relating to my application, including academic transcript/s,
might invalidate my application and that the University may withdraw an offer of a place or cancel my enrolment in consequence. I
understand that should the information be shown to be false at any stage, 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.
Should the University determine that I have submitted a false document, I consent to the University disclosing the information to other
relevant tertiary institutions.
I consent to any educational institution at which I have previously been a student and/or my current or any past employer, 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. I agree to abide by the statutes, regulations and policies of Monash University.
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 have read and understood the above conditions and accept them fully.

Signature of applicant: Date: / /

Application closing dates: refer to the website (same closing dates for both scholarships)
www.study.monash/fees-scholarships/scholarships/find/international-student-scholarships/international-merit
Send your completed applications to:
Central Admissions
Monash Connect, Clayton Campus
21 Chancellor’s Walk, Campus Centre
Monash University
VIC 3800, Australia

Email: mu.documents@monash.edu

Enquiries: scenquiries@monash.edu