T he situation

f ro m hence a
bearings, to b
e ast. No land
n orth as whe
t h e horizon,
b e very low,
f ast decreasi
of Moun
nd from
e 34° 59

re the tr
which s
and our
ng.
t L o ft y w a s f o u n
so m e o t h e r c r o s s
' south and 138° 42'

was visib
le s o f a r t o t h e
ees appeared abov
howed the coast to
so u n d i n g s w e r e
d

e
From
miles
shore
to eig
fatho
a bot
dead
noon to six o'cloc k w
to the northwar d , sk
at the distance of fiv
ht miles; the dep t h wa
ms, and we dropp e d the
tom of sand, mix e d with
coral.
e ran thirty
irting a sandy
e, and thence
s then 5
anchor upon
pieces of
F L I N D E RS UN IVERS I TY
ADELAIDE • AUSTRALIA

D & F Steinle family memorial

Scholarship
Application Form

Notes for Applicants

A bequest has been made to the Flinders Medical Centre Foundation for the establishment of an annual scholarship to help a first year
medical student to buy textbooks. The following rules will apply to the scholarship:
1. The Scholarship will be known as the D & F Steinle Family Memorial Scholarship.
2. The value of the scholarship will be a $1000 book voucher.
3. The scholarship will be awarded annually by the Flinders Medical Centre Foundation on the recommendation of the BMBS
Admissions Committee. Commencing students will be invited to nominate for the scholarship, which will be awarded on the basis of
combined criteria relating to academic merit and financial need.
Academic merit will be based on the student’s selection score on admission to the course.
Applications must be lodged with the Secretary, BMBS Admissions Committee, Faculty of Health Sciences, Flinders University,
GPO Box 2100, Adelaide SA 5001, Australia by 15 April 2011.

Section A: Personal Details

A1 Student ID number:

A2 Family Name:

A3 Other Names:

A4 Title:

A5 Address:

A6 E-mail address:

A7 Phone Number:

Section B: Financial Details

B1 State the combined taxable income (not including Youth Allowance or Austudy) for the financial year to
30 June 2009 of:
 you and your partner (if you were aged 25 years or older on 1 January 2011); or
 you and your parent(s)/guardian(s) or partner (if you were aged under 25 years on 1 January 2011):

 Please attach documentary evidence to substantiate your response to

this question.
B2 State the combined taxable income (not including Youth Allowance or Austudy) for the financial year to
30 June 2010 of:
 you and your partner (if you were aged 25 years or older on 1 January 2011); or
 you and your parent(s)/guardian(s) or partner (if you were aged under 25 years on 1 January 2011):

 Please attach documentary evidence to substantiate your response to

this question.
B3 Indicate whether you are receiving in 2011 any of the following:

Amount per week

1. Youth Allowance

2. Austudy

3. Abstudy

Amount per week

4. Other means-tested benefit  Please specify:

 Please attach documentary evidence to substantiate your response to this question (e.g. copies of recent
letters from Centrelink).
B4 Have you obtained any prizes, scholarships or other awards to assist you to study in 2011?

No.

Yes.  Please provide details of these

awards, including value. Attach
additional sheets if this space is
insufficient.

B5 Have you applied for any prizes, scholarships or other awards, whose outcome has not yet been determined, to
assist you to study in 2011?

No.

Yes.  Please provide details of these

awards, including value. Attach
additional sheets if this space is
insufficient.

B6 Have you taken out a loan to support your studies in 2011?

No.

Yes.  Please provide details of the

loan, including its value. Attach
additional sheets if this space is
insufficient.

B7 Do you have any special circumstances that should be taken into consideration in assessing your financial
circumstances? Special circumstances may include: additional costs associated with a disability, extraordinary
travel expenses, other items of an extraordinary, unavoidable, ongoing nature.

No.

Yes.  Please provide details.

Attach additional sheets if this
space is insufficient.

B8 If you were aged under 25 years on 1 January 2011, please provide the name(s) and details of your
parent(s)/guardian(s) below:

Parent/Guardian Name:

Relationship to you: Phone number:

B8 continued:

Parent/Guardian Name:

Relationship to you: Phone number:

B9 If applicable, please provide the name and details of your partner below:

Partner Name:

Relationship to you: Phone number:

B10 Estimate below your fortnightly living expenses and income during the 2011 academic year:

Food and toiletries: Employment earnings:

Rent and accommodation: Austudy/Youth Allowance:

Rates, gas and electricity: Family benefits:

Telephone: Other Centrelink benefits:

Insurance: Other income:

University fees, books, stationery: Total fortnightly income:

Doctor, dentist, optician, chemist:

Clothing, hairdressing: Other sources of Financial Support

Child care expenses: Contribution from parents:

Car expenses: Contribution from partner:

Other travel expenses: Savings:

Entertainment: Total fortnightly support:

Other expenses:

Total fortnightly expenses:

Section C: Personal Statement

C1 Please provide a statement below and on the next page, detailing your reasons for applying for this scholarship.
Describe how your studies will be enhanced by the scholarship providing a book voucher. Attach additional sheets
if necessary.
 C1 continued:

Checklist

Yes No Not
Incomplete applications will not be considered. Have you attached: Required
 Evidence of combined taxable income and of eligibility for Youth Allowance, Austudy,
Abstudy, or other means-tested benefit (see questions B1-B3).
 Details of any prizes, scholarships or other awards that you have obtained to assist you to
study in 2011 (see question B4).
 Details of any prizes, scholarships or other awards that you have applied for to assist you
to study in 2011 (see question B5).
 Details of any loans that you have taken out to assist you to study in 2011(see question
B6).
 Details of any special circumstances that should be taken into consideration in assessing
your financial circumstances (see question B7).

Declaration

 I declare that the information supplied by me in my application for this Scholarship is complete, true and correct in
every particular.
 I acknowledge that the submission of incorrect information relating to my application may result in the withdrawal of
any offer of scholarship, and that this withdrawal may take place at any time during my enrolment.

Signature of Applicant: Date:

22/3/2011