Application Form Step 1 of 8 12% The Charles Allan Seymour Hawker Memorial Scholarship Tenable at one of the following Universities and affiliated Colleges: The Australian National University – Burgmann College The Flinders University of South Australia – St Mark’s College The University of Adelaide – St Mark’s College The University of Adelaide – Roseworthy Campus The University of Cambridge – Trinity College The University of New England – Robb College The University of South Australia – St Mark’s College The Marcus Oldham College Preference will be given to applicants with aspirations to enter public affairs, politics, community service or any other such activity considered beneficial to Australia. The tenure of the scholarship is determined by the Trustees and is normally for three years. . Value: College fees to a level as determined by the Trustees. 1. NAME: (in full)* Mr Mrs Miss Ms Other OtherName*2. EMAIL* TELEPHONE NUMBER:* 3. HOME ADDRESS:*TOWN/CITY:*POST CODE:*ADDRESS FOR CORRESPONDENCE (if different to above):TOWN/CITY:POST CODE:TELEPHONE NUMBER: 4. DATE OF BIRTH:* Date Format: MM slash DD slash YYYY PLACE OF BIRTH* 5. EDUCATION (please complete whatever is applicable): 5. Education*Level (Secondary/Tertiary)Name Of InstitutionYears Attended (ie. 2015 to 2019)Stage Completed 6. ACADEMIC RECORD: Please attach a copy of your most recent academic results*Accepted file types: jpg, png, pdf, doc, docx.Max. file size 2MB 7. PROPOSED COURSE OF STUDY:*8. UNIVERSITY & COLLEGE YOU PROPOSE TO ATTEND*The Australian National University - Burgmann CollegeThe Flinders University of South Australia - St Mark's CollegeThe University of Adelaide - St Mark's CollegeThe University of Adelaide - Roseworthy CampusThe University of Cambridge - Trinity CollegeThe University of New England - Robb CollegeThe University of South Australia - St Mark's CollegeThe Marcus Oldham College A MINIMUM OF TWO WRITTEN REFERENCES MUST BE INCLUDED WITH YOUR APPLICATION. You may provide additional referees. The contact details of two of your referees must be included to allow the Trustees to make further enquiries. You can also include an additional 2 referees' contact details for consideration if you choose:9. REFERENCES: Please attach a copy of your written references*Accepted file types: pdf, jpg, png, doc, docx.Max. file size 2MB*Accepted file types: pdf, jpg, png, doc, docx.Max. file size 2MB I wish to add additional references Additional References (optional)Accepted file types: jpg, png, doc, docx, pdf.Additional References (optional)Accepted file types: jpg, png, doc, docx, pdf.Contact Details of Referee 1*NameMobileEmailContact Details of Referee 2*NameMobileEmailOther Referees (optional)NameMobileEmail Max. 2 additional referees FURTHER INFORMATION: An applicant is required to attach a statement giving further information about his or her background, reasons for studying the course they have chosen and their envisaged future career. Interest (if any) in public service or politics, hobbies and any other matter which the applicant thinks may be of interest to the Trustees could also be included. Such statements should be one page and no more than two A4 pages of 12 point type in length.10. PERSONAL STATEMENT: Please attach a statement*Accepted file types: jpg, pdf, doc, docx, png.Max. file size 2MBDate Date Format: MM slash DD slash YYYY Name*PhoneThis field is for validation purposes and should be left unchanged.