3558-V1 0913

Phyllis Budd Annual ScholarshipApplication Form

The Phyllis Budd Annual Scholarship has been established to assist apprentice chefs who are undertaking their training through William Angliss Institute, in helping them to achieve their career ambitions. The scholarship will provide recipients with much needed training equipment and opportunities such as interstate and overseas travel to assist with their career development outcomes.

Scholarship Funding One annual scholarship to the value of $4,000 (AUD) will be available to 2nd and 3rd year apprentices who are undertaking their Certificate III in Hospitality (Commercial Cookery) Apprenticeship at William Angliss Institute.

General Information for ApplicantsScholarship applicants should note the following:

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Application Instructions1. Carefully read the eligibility criteria and terms and conditions applicable to this scholarship www.angliss.edu.au/foundation.

2. Complete all sections in block letters ineligible hand written applications will not be considered.

3. Ensure you enclose all supporting documentation with this application: t "DBEFNJDUSBOTDSJQUT t 1IPUPDPQZPGZPVSQBTTQPSUBOEPSCJSUIDFSUJmDBUF t &WJEFODFPGmOBODJBMIBSETIJQJGBQQMJDBCMF

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4. Sign the application form

5.5IFBQQMJDBUJPOGPSNBOEPUIFSSFMFWBOUEPDVNFOUBUJPONVTUCFDPNQMFUFEBOETVCNJUUFEJOEVQMJDBUFCZno later than 15 November for semester 1 UPUIF'PVOEBUJPO0GmDFSBU8JMMJBN"OHMJTT*OTUJUVUF

Foundation Officer William Angliss Institute 10#PY Melbourne VIC 3000

1I Email: foundation@angliss.edu.au

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3558-V1 0913

Phyllis Budd Annual ScholarshipApplication Form

5JUMMF .S .ST .T %S 0UIFS/BNF1PTJUJPOOrganisation:

Relationship to referee:

5FMFQIPOF ( )

Mobile: ( )

Application Details4UVEFOU*% $PVSTF/BNF$BNQVT "QQSFOUJDFTIJQ:FBS nd Year 3rd Year "SFZPVDVSSFOUMZFOSPMMFEXJUIBOPUIFSFEVDBUJPOQSPWJEFS :FT /P*GZFTQMFBTFJOEJDBUFUIF4DIPPMPS5FSUJBSZ1SPWJEFSZPVBSFDVSSFOUMZFOSPMMFEBOEXIBUDPVSTFPSZFBSMFWFMZPVBSFDVSSFOUMZVOEFSUBLJOH&EVDBUJPO1SPWJEFS/BNF $PVSTF:FBS-FWFM

Personal Details 5JUMMF .S .ST .T %S 0UIFS'BNJMZOBNFGiven name(s):

%BUFPG#JSUID D / M M / Y Y Y Y 4FY .BMF 'FNBMFCurrent Age:

Country of birth:

Home address

Address:

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5FMFQIPOF ( ) Mobile: ( )

'BY ( ) Email (mandatory)

Contact Details of Two RefereesReferee 1 (Teacher, trainer or student counsellor): Referee 2 (Employer):

5JUMMF .S .ST .T %S 0UIFS/BNF1PTJUJPOOrganisation:

Relationship to referee:

5FMFQIPOF ( )

Mobile: ( )

3558-V1 0913

Phyllis Budd Annual ScholarshipApplication Form

Written statement1MFBTFTVQQMZBXSJUUFOTUBUFNFOUNBYJNVNXPSETTVQQPSUJOHZPVSBQQMJDBUJPO*GUIFSFJTOPUFOPVHISPPNCFMPXQMFBTFBUUBDIBOZadditionaldocuments.

:PVSTUBUFNFOUTIPVMEBEESFTTZPVSSFBTPOGPSBQQMZJOHGPSUIFTDIPMBSTIJQCVSTBSZBOEJGSFRVJSFEUIFTFMFDUJPODSJUFSJBSFMFWBOUUPUIFTDIPMBSTIJQZPVare applying for (please refer to www.angliss.edu.au/foundation).

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Checklist $PNQMFUFEBMMRVFTUJPOPOUIFBQQMJDBUJPOGPSN

Attached your written statement/s addressing the selection criteria

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Submitted academic results from the most recent semester

Submitted evidence of financial hardship (if applicable)

Submitted written assessment from student counsellor (if applicable)

Submitted letter from medical practitioner (if applicable)

Submitted a copy of any relevant information that would support yourapplication

Read and understood the terms and conditions of the scholarship application process (available at www.angliss.edu.au/foundation)

Signed the application form

Enclose copies of all supporting documentation with thisapplication

Please note: As part of the assessment process you may be required to submit additional information.

3558-V1 0913

Phyllis Budd Annual ScholarshipApplication Form

DeclarationI declare that the information provided is, to the best of my understanding and knowledge complete and correct. I am aware that there are severe penalties for providing false or misleading information. I understand and acknowledge that there may be a need for William Angliss Institute to share myinformation with a third party, such as donors and sponsors etc. I give my permission for William Angliss Institute to supply any relevant official records in accordance with the terms and conditions and privacy legislation.

Signature: Date: D D / M M / Y Y Y Y

Submitting the application5PCFFMJHJCMFBQQMJDBUJPOTNVTUCFTVCNJUUFE no later than 15 November for semester 1.5IFBQQMJDBUJPOGPSNBOEPUIFSSFMFWBOUEPDVNFOUBUJPONVTUCFDPNQMFUFEBOETVCNJUUFEJOEVQMJDBUFUPUIF'PVOEBUJPO0GmDFSBU8JMMJBN"OHMJTT*OTUJUVUFFoundation Officer William Angliss Institute 10#PY Melbourne VIC 3000 1I Email: foundation@angliss.edu.au

Office use only

4DIPMBSTIJQCVSTBSZBQQMJDBUJPO.FSJU&RVJUZScholarship/bursary successful:

Scholarship/bursary unsuccessful:

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Signature: Date: D D / M M / Y Y Y Y