UNIVERSITY OF WOLLONGONG

PAUL WAND INDIGENOUS STUDENT PRIZE

APPLICATION FORM

Closing date for applications is 30^th November 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:

______________________________________________________________

Year of course: ___________

Do you intend to continue to study full time at University of Wollongong in 2010? YES / NO

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

Signature _________________________ Date________________

ADDITIONAL INFORMATION

Please address the criteria in no more than 2 pages.

1. Academic Merit

Please provide some background and supporting documentation on your academic achievements to date.

2. Financial Need

Please tell us about how the Prize would assist you to achieve your academic goals.

3. Leadership and Contribution to the Community

At the end of your studies, how do you intend to use your qualifications, and what aspirations do you have for further study or for a career? Describe your current leadership and community involvement.