PART A: Personal details
Family name: ................................................................................First name: ................................................................................
Course applying for:
....................................................................................................................................................................
Yes o No o
Graduate Access Melbourne
Supplementary form to be completed by Graduate Access Melbourne applicants applying
under the Disadvantaged socioeconomic circumstances category for:
• The Melbourne Juris Doctor (JD)
• Faculty of Business and Economics courses
• Faculty of the Victorian College of the Arts and Melbourne Conservatorium
of Music courses
• Graduate School of Humanities and Social Sciences (GSHSS)
courses
Graduate Access Melbourne
Yes o No o
Yes o No o
Student/Application ID number
...............................................................................................................
PART B: Disadvantaged socioeconomic circumstances
Have you experienced financial hardship during your tertiary study?
Did you experience disadvantaged socioeconomic circumstances prior to your tertiary study?
Have you experienced disadvantaged socioeconomic circumstances since your tertiary study?
You must
attach:
•
A supporting statement from a relevant independent third party such as an
accountant, financial counsellor, teacher, or other person with relevant knowledge. The statement
should confirm the existence and duration of the circumstances and any subsequent change to
them for you and/or your family (as relevant); and
•
Any other supporting documentation that provides evidence of your financial need, for
example, family receipt of Centrelink payments, receipt of Family Tax Benefit Part A and Part B.
(If circumstances prevent you obtaining supporting documentation, please supply a statement
explaining the reasons.)
o
Attached
o
Attached
Do you currently receive, or are you eligible to receive, a Centrelink allowance or pension?
Examples: Youth Allowance, Rent Assistance, New Start Allowance
If yes, you must attach a statement from Centrelink, including:
Your name,
Title and dates of the benefit(s) received or eligible to you, and
The statement must be dated within the three months before your application is submitted.
Yes
o No
o
Personal Statement
Describe your socioeconomic circumstances, including how they have had a sustained adverse effect on your academic achievement in tertiary study (if
applicable). If relevant, explain the absence of support payments from Centrelink. An additional sheet may be attached to the application form if required. The
statement should not exceed 750 words.
PART C: Applicant budget – expenses
You are required to submit your estimated and known expenses for the period 1 January to 31 December this year. You are also required to include your
spouse/partner’s and any dependants’ expenditure (if applicable). Please provide expenses for other year(s) on additional pages if the circumstances are
relevant and substantially different. Please round all amounts to the nearest dollar.
Weekly expenses
Annual expenses (Other)
Annual expenses (Course related)
Car costs (registration, insurance etc.)
$
Medical and dental costs
$
Outstanding debts
Credit card
$
Short-term
University
loan
$
Other loans
$
TOTAL DUE DEBTS $
Any other expenses:
.................................................................................
$
TOTAL OTHER COSTS [C]
TOTAL ANNUAL EXPENSES (A
+
B
+
C
ABOVE) [D]
$
Course materials
$
Student Union membership
$
Other course related expenses
(eg, fees if ineligible for HECS/FEE-Help):
.................................................................................
$
T
O
T
A
L
CO
U
R
S
E
R
E
L
A
T
E
D
E
X
P
EN
S
E
S
[
B
]
$
Accommodation Rent
$
Board
$
Residential College fees
$
Mortgage payment
$
Bills (gas, electricity, telephone, water, Internet)
$
Food (lunches, groceries, etc.)
$
Transport (public transport, petrol, parking)
$
Spending money (clothing, entertainment, etc.)
$
Commitments to dependents
$
Other weekly expenses
$
TOTAL WEEKLY EXPENSES
$
X WEEKS = [A]
$
PART D: Applicant Budget – income
You are required to submit your estimated and known income for the period 1 January to 31 December this year. You are also required to include your
spouse/partner’s and any dependants’ income and family support (if applicable). Please provide income for other year(s) on additional pages if the
circumstances are relevant and substantially different. Please round all amounts to the nearest dollar.
Employment income (Gross average weekly earnings)
Other weekly income (Average weekly earnings)
Lump sum or other income (Annual amounts)
FINANCIAL NEED SUMMARY
Savings at 1 January
$
Income from parents/family
$
Term deposits
$
Shares
$
Scholarships
and
other
grants
Specify:
$
Other Specify:
$
TOTAL LUMP SUM OR OTHER INCOME [G] $
TOTAL EXPENSES [D]
$
TOTAL INCOME [H]
$
DEFICIT / SURPLUS [D] — [H]
$
C
e
n
tr
e
li
nk
pa
ym
e
n
t
s
Youth allowance, specify type:
Dependent (parental income test
applied) or
Independent (usually over 22)
$
o
Yes
o
No
Rent assistance $
Other (specify):
$
P
a
r
t
n
e
r
/S
pou
se
'
s
i
n
c
o
m
e
$
T
O
T
A
L
O
T
H
E
R
W
EE
K
LY
I
N
CO
M
E
$
X WEEKS = [F]
$
TOTAL INCOME FOR THIS YEAR
(E
+
F
+
G ABOVE) [H]
$
Period Weekly amount
Totals
January – February $ x 9 weeks
$
March – November $ x 39 weeks
$
December $ x 4 weeks
$
TOTAL EMPLOYMENT INCOME [E]
$
o
Yes
o
No
$
STATEMENT ON PRIVACY POLICY
When dealing with personal or health information about
individuals, the University of Melbourne is obliged to comply
with the Information Privacy Act 2000 and the Health Records
Act 2001.
For further information refer to:
www.unimelb.edu.au/unisec/privacy
DISCLAIMER
The University has used its best endeavours to ensure that
material contained in this publication was correct at the time
of printing. The University gives no warranty and accepts no
responsibility for the accuracy or completeness of information
and the University reserves the right to make changes
without notice at any time in its absolute discretion.
INTELLECTUAL PROPERTY
For further information refer to:
www.unimelb.edu.au/Statutes/
Copyright in this publication is owned by the
University and no part of it may be reproduced
without the permission of the University.
PUBLISHER
Authorised by: Associate Director, Enquiries and
Admissions,
Office of Admissions
Published by: Office of Admissions
Copyright: The University of Melbourne, September 2013
CRICOS PROVIDER CODE: 00116K
PART E: Declaration and signature
• I declare that all information I have provided in this supplementary form is true and complete.
• I declare that all supporting documentation is provided complete and unaltered.
• I
acknowledge that the University of Melbourne reserves the right to reverse or vary any decision regarding
admission made onthe basis of false information.
• I understand that in investigating the veracity of the information I have provided, the University of Melbourne may
require me torepeat the biometric component of any English language proficiency test I have undertaken.
• If I have misrepresented my past and/or present circumstances I acknowledge that the University may terminate my
studies andthat the University may terminate my studies at any stage during the course undertaken.
• I understand that if I am awarded a scholarship from the University I must not hold another equivalent award at the
same timefrom the University or any other organisation. If I am awarded a scholarship from the University which is
based on false or
misleading information I have provided in my application (or subsequently), I will be required to
repay to the University anyscholarship(s) that I have received. Scholarship benefits include living allowances, fee
remission and travel allowances.
• I understand that the personal information that I have provided in my application (or subsequently) may be released:
• To Australian Commonwealth and State agencies under the Education Services for Overseas Students (ESOS)
Act 2000;
• To the Department of Education, Employment and Workplace Relations (DEEWR) and that DEEWR will collect
and store my
personal information in the Higher Education Information Management System; or
• As required to be disclosed by law.
• I acknowledge that all documents submitted become the property of the University of Melbourne and will not be
returned.
Name
of applicant: ...............................................................................................................................................................................................
Signature: .....................................
.................................................................Day................................Month....................Year...........................
Submit your application
This supplementary form should be submitted in support of your full Graduate Access Melbourne application form.
Please follow the
submission instructions detailed on the Graduate Access Melbourne application form:
www.gradaccess.unimelb.edu.au