La Trobe Access Scholarship Application Form

This form is an application for the Golden Lanyard Scholarship which is awarded to students who can prove disadvantage. Please ensure you have attached all of your supporting documents and wait for them to upload before you press submit. Applications that are submitted without supporting documentation will not be considered. For information on the types of supporting documentation please visit: supporting documentation.

Required fields are marked with an asterisk (*).


My details
Gender *
Date of Birth *
Please use your La Trobe email
Do you reside in a regional, remote or very remote area? * Check the Health Workforce Locator site (Check the 2016 box next the "ASGS Remoteness Areas")

Personal circumstance
Are you the first person in your immediate family to attend university? * (immediate family = parents, brothers, and sisters)
Are you of Aboriginal Australian or Torres Strait Islander descent? *
Do you speak another language at home other than English? *
Have you ever spent time in formal out-of-home care? * (e.g. foster care, residential care, kinship care or been a ward of the state)
Do you have a medical condition or disability which impacts your ability to study? * Examples of medical conditions and disabilities include but are not limited to: Physical impairment (e.g. blindness), Learning disabilities (e.g. dyslexia), Chronic pain, Eating disorder (e.g. anorexia), Mental illness (e.g. depression), Major illness (e.g. cancer)
Personal statement 2500 characters
You must provide a statement of support from a medical professional who treated or is currently treating your condition(s)/disability.
(.pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB)
Are you or have you been a refugee? * Note: a refugee is someone who has had to leave or abandon his/her native country due to persecution or fear of persecution on account of race, religion, personal associations, or political opinion and has been granted either a temporary or permanent humanitarian visa. An asylum seeker is applying for refugee status.

Family circumstance
What is your Household structure? *
Do you have Children? *

Financial circumstance
Has your education been adversely affected by your financial circumstances or do you expect your tertiary education to be adversely affected by your financial circumstances? *
(e.g. Austudy, ABSTUDY, Job Seeker or Family Tax Benefit)
For information on suitable evidence check our supporting documentation requirements website.
(.pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB)
Please provide the following information regarding your financial circumstances.
Household income includes you, your parents or guardians, or your partner.
(e.g. Australian Tax Office Notice of Financial Assessment for the previous financial year or 3 consecutive pay slips dated within the last 3 months of the scholarship application. .pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB)

Other difficult circumstances
Has your education been disadvantaged by difficult circumstances not outlined above? * (examples of difficult circumstances may include abusive family circumstances, excessive carer duties, chronic medical condition of a child, death of close relative, homelessness, recent multiple relocations, recent separation of parents, relationship breakdown, victim of crime, bullying.)
(to receive consideration for this criteria, we require supporting evidence)* Personal statement 2500 characters
(This may be in the form of a statement by a relevant responsible person. For example; health care professional, social worker, counsellor, religious or community leader, school principal or teacher etc, unrelated to you as the  applicant, who can verify the circumstances. Applicants who do not supply supporting documents will not be considered for a scholarship..pdf, .doc, .docx, .jpg or .png file types only. Max file size 8MB)


All information provided by applicants will be treated as confidential. At La Trobe University, we respect the privacy of your personal information. We collect personal information in your application to determine your eligibility for a scholarship, bursary or grant, and to assess your application as part of the ranking and allocation process. In accordance with privacy laws, personal information about you contained in your application will not be used for any other purpose or disclosed to any person who is not part of the La Trobe assessment and allocation process, without your permission. You may have the right to access personal information we hold about you, subject to any exceptions in relevant laws, by contacting the Scholarships Office. The La Trobe University privacy policy can be viewed at: