UNIVERSITY OF WOLLONGONG

SUSAN OWEN MEMORIAL PRIZE

APPLICATION FORM

Closing date for applications is 30^thNovember 2009.

Applicants should be available on the evening of the 8^th December 2009 to accept the Prize if successful.

Name: ________________________________________________

Address: ________________________________________________

______________________________________Postcode: ____________

Telephone: _____________________________

Date of Birth: ________________________

Student No: ________________________

Which course are you enrolled in at the University of Wollongong:

___________________________________________________________

I certify that I am an Aboriginal or Torres Strait Islander student and that I am currently enrolled in the University of Wollongong on a full time basis.

Signature _________________________________ Date_______________

ADDITIONAL INFORMATION

Please address the criteria in no more than 2 pages.

1. At the end of you undergraduate studies, how do you intend to use your qualifications, and what aspirations do you have for further study or for a career?

2. Could you please give us a brief outline of your interests and academic achievements?

3. Could you please tell us how the prize money will assist you with your studies?