Victorian Flood Relief Bursary application form IMPORTANT!! This bursary is for students enrolled at Mildura Campus or those students studying online with a Mildura home address. Please ensure that evidence of any flood-related disaster payments you received are uploaded in the required format and correctly configured. If your internet connection is slow, ensure that your file is given sufficient time to upload before you click the submit button.Please provide the following information: Given name * Family name * Student ID number Student email address * (this must be your La Trobe student email address eg: J.Bloggs@students.latrobe.edu.au) Street address * City / Suburb / Town * Postcode * Personal circumstanceIn what way has the flood affected your studies? Select all reasons applicable to your situation. * You may select more than one. Travel to campus restricted Damage to equipment used for study Living in alternative accommodation Loss of power for more than 24 hours Please attach evidence of any flood-related disaster payments from Centrelink or the State or Federal Government. This payment can be for yourself or your immediate family and this evidence will be prioritisied during the selection process.(PDF, PNG or JPG file types only. Max 8MB file size) Are you registered with AccessAbility? * https://www.latrobe.edu.au/students/support/wellbeing/services/accessability-hub Yes No Please indicate how many dependent children you have under the age of 16 * Children must be in your care. -- Please Select --0123456 or more Have you been able to work since the floods? * Yes No I don't have current employment Are you able to supplement lost income from other sources of financial support? * Other sources may include a partners income or money from a parent/care giver. Yes No I have not lost income Do you currently receive Centrelink payments? * E.g. Youth Allowance, Abstudy, JobSeeker, Parenting Payment, Family Tax Benefit. Yes No Declaration * I declare that the information provided in this form is true and correct I agree that decisions of the University are final and that no correspondence will be entered into regarding the outcome of this application Privacy 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: www.latrobe.edu.au/privacy Validation
