Application Form Step 1 of 2 50% The Charles Allan Seymour Hawker Memorial Scholarship Trust Fund 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 avowed aspirations to enter actively into the Australian political field, public affairs, community service or any other such activity considered beneficial to Australia”. Period of Tenure: as determined by the Trustees, but normally 3 years or possibly 4 years. Value: College fees to a level as determined by the Trustees. 1. NAME: (in full)* Mr Mrs Miss Ms Name*2. HOME ADDRESS:*TOWN/CITY:*POST CODE:*TELEPHONE NUMBER:*ADDRESS FOR CORRESPONDENCE:TOWN/CITY:POST CODE:TELEPHONE NUMBER:3. DATE OF BIRTH:* Date Format: MM slash DD slash YYYY PLACE OF BIRTH* 4. EDUCATION (please complete whatever is applicable): Education*LevelName Of InstitutionYears AttendedStage Completed Please attach a copy of your most recent academic results*Accepted file types: jpg, png, pdf, doc, docx.PROPOSED COURSE OF STUDY:*UNIVERSITY AND COLLEGE YOU PROPOSE TO ATTEND:*8. A MINIMUM OF TWO WRITTEN REFERENCES IS REQUIRED. The contact details of two referees should be included to allow the Trustees to make further enquiries:Contact details of two referees*NameMobileEmail 9. FURTHER INFORMATION: An applicant is required, to attach a statement giving further information about his or her background; reasons for seeking entry to the course chosen; envisaged future career, interest (if any) in public service or politics, hobbies; and any other matter which may be thought to be of interest to the Trustees. Such statements should desirably be of one page, but in any case should be no more than two A4 pages of 12 point type in length.Please attach a statement*Accepted file types: jpg, pdf, doc, docx, png.Date Date Format: MM slash DD slash YYYY Name*PhoneThis field is for validation purposes and should be left unchanged.