Education Support Fund 2020 Student Application The Education Support Fund (ESF) was launched in 2013 to grant financial support to young and mature aged students who are transitioning into third level education. While it's an exciting time of year for our rural students, we acknowledge that it can be financially challenging to relocate and buy supplies for new classes. This named perpetual fund is in place in conjunction with the Mirboo North and District Community Bank® so that together we can assist local students Educational Support Fund 2020 - Student Application Step 1 of 5 20% Name* First Name Last Name Email* Mobile NumberHome NumberPostal Address* Address Line 1 Address Line 2 Town State Postal Code Residential Address (if different from postal) Address Line 1 Address Line 2 Town State Postal Code Are you an Australian citizen or permanent resident of Australia*YesNoAre you a resident of the Mirboo North District (including Allambee, Allambee South, Berry’s Creek, Boolarra, Boolarra South, Budgeree, Childers, Darlimurla, Delburn, Dumbalk, Hallston, Mardan, Mirboo North, Mirboo, Narracan, Thorpdale, Yinnar, Yinnar South)*YesNoIf no, do you have a demonstrable connection to the Mirboo North District ?YesNo (If your answer is No, you are not eligible)If yes, please provide details, if required please upload any supporting documents Drop files here or Accepted file types: jpg, gif, png, pdf. Are you applying for your first year in a post secondary level course at an Australian educational institution that is recognised by the Australian educational authorities in 2021. (This can be tertiary or vocational, eg University, TAFE, Post-graduate qualification).YesNo (If your answer is No, you are not eligible to receive support)Have you received an Educational Support Fund award from us previously?YesNo What course have you applied for? (Please include your top two preferences)Educational InstitutionCourse Current Education StatusLevel ObtainedName of School / InstitutionYear started and completedQualification Why do you want to undertake your chosen Course(s)? Challenges impacting on your education: (Tick any that apply to you; or add other) Regional and Remote location (all residents of our District qualify) Low income Difficult personal circumstances Disability or long-term medical condition Family Health Care Card Indigenous Non-English speaking Refugee or asylum seeker Carer responsibilities Sole parent responsibilities Other OtherWhat are the barriers to you completing further study? Please refer to each of the challenges you have ticked in the previous question.How would you use the Education Support Fund award?(Your response won’t affect your application.)Is there any additional information you would like to provide to support your application? E.g. Will you have any financial support in meeting the costs of your tertiary course? E.g. Give details of any awards or scholarships you have applied for (even if the outcome is not yet known).Community Involvement. We would love to hear how you are involved with your community or school and what interests you have.(Your response won’t affect your application. As a community-based organisation we are interested in how people are connecting with their communities.) A referee must complete a Reference Form, which is to be submitted online to complete your application. Your referee must address the challenges you have indicated in your application. Please contact your referee and ask them to complete the form on our website. Please provide Referee’s details below:Name / TitlePhoneEmail Attach referee formSection BreakPlease tick all boxes* I declare that all the information provided in this application is true and correct. I understand that if the Mirboo North & District Community Foundation approves support, I will be required to accept the conditions of the grant as outlined in the Mirboo North & District Community Foundation Educational Support Fund Grant Agreement. I give permission to the Mirboo North & District Community Foundation to contact any persons or organisation in the assessment of the application. Date Date Format: MM slash DD slash YYYY Name* First Name Last Name CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.