This Scholarship Acceptance Form is for students to accept their offer of scholarship after they have read through their scholarship offer letter and terms and conditions. If you wish to decline the offer, please fill out this form.

Please visit Undergraduate Scholarships website for further details regarding the scholarship, or contact the Undergraduate Scholarships Office by sending an email at www.undergradschols.unimelb.edu.au/query (click on the Send Us an Email tab).

If you have been offered more than one scholarship, you will need to submit a separate acceptance form for each scholarship.

Privacy Statement

The information on this form will be used by the Undergraduate Scholarships Team for scholarship processing. For information on the university's privacy policy, please visit http://www.unimelb.edu.au/unisec/privacy/.

Section A - Personal Details
	* Mandatory    Document Submission
VTAC Number:* (Your VTAC number must be 8 numbers and 1 alphabet)
Date of birth:*	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   --Month-- January February March April May June July August September October November December   Year 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992
Student ID: (if you have one)
Title:* (eg. Mr, Ms, Miss)
Given Name(s):*
Family Name:*
Section B - Scholarship Acceptance
1.*  I have carefully read the scholarship letter of offer and Terms and Conditions for my scholarship, and I hereby accept the scholarship and the conditions on which it is offered:	------ Select ------ New Generation Undergraduate Award New Generation International Undergraduate Scholarship New Generation International Graduate Scholarship Melbourne National Scholarship Melbourne National Medicine Scholarship Melbourne Graduate Access Bursary Melbourne Access Scholarship Melbourne Abroad Scholarship Kwong Lee Dow Young Scholars Scholarship International Undergraduate Fee Remission Scholarship Commonwealth Indigenous Access Scholarship Commonwealth Education Costs Scholarship Commonwealth Accommodation Scholarship Commonwealth Associate Degree Scholarship CAS Commonwealth Associate Degree Scholarship CECS
2.*  Scholarship recipients Are you currently in receipt of another Melbourne Scholarship?	Select Yes No   If yes, select:  ------ Select ------ New Generation Undergraduate Award New Generation International Undergraduate Scholarship New Generation International Graduate Scholarship Melbourne National Scholarship Melbourne National Medicine Scholarship Melbourne Graduate Access Bursary Melbourne Access Scholarship Melbourne Abroad Scholarship Kwong Lee Dow Young Scholars Scholarship International Undergraduate Fee Remission Scholarship Commonwealth Indigenous Access Scholarship Commonwealth Education Costs Scholarship Commonwealth Accommodation Scholarship Commonwealth Associate Degree Scholarship CAS Commonwealth Associate Degree Scholarship CECS
3.*  Photo Consent The University regularly reproduces photographs of people for teaching purposes in its publications, promotional and marketing material and on its web site in order to promote the University to the public. The University has a comprehensive policy addressing issues related to the use, collection, security and access to personal information. Do you agree to the University releasing and using information about you and your photograph for publications and promotional and marketing purposes? Select Yes No
4.  Banking Details If your scholarship includes an allowance, please download a Bank Details form and submit it by the date specified in your letter of offer to: The Scholarships Officer, Undergraduate & Graduate Coursework Scholarships Team, Melbourne Scholarships Office, The University of Melbourne, Victoria 3010
5.  Airfare Arrangements If you have been offered a National (Interstate) Scholarship or a National Medicine (Interstate) Scholarship please download an Airfare Arrangement form (PDF : 24Kb) and submit it by the date specified in your letter of offer to: The Scholarships Officer, Undergraduate & Graduate Coursework Scholarships Team, Melbourne Scholarships Office, The University of Melbourne, Victoria 3010
Section C - Only for students who have been offered a Commonwealth Scholarship
6.  Centrelink Benefits Do you receive Centrelink Benefits?	Select Yes No If yes, name of benefit:  ------ Select ------ ABSTUDY Austudy Carer Payment Disability Support Pension Family Tax Benefit Part A Family Tax Benefit Part B Parenting Payment Youth Allowance Other If Other, please state:
7.  If you have been offered a Commonwealth Scholarship
7a.  Have you received a Commonwealth Scholarship at another institution?	Select Yes No If yes, name of scholarship:  ------ Select ------ Commonwealth Indigenous Access Scholarship Commonwealth Education Costs Scholarship Commonwealth Accommodation Scholarship Commonwealth Associate Degree Scholarship CAS Commonwealth Associate Degree Scholarship CECS The scholarship was awarded from:  Year 2004 2005 2006 2007  to  Year 2004 2005 2006 2007
7b.  You are not eligible to receive a Commonwealth Indigenous Access Scholarship if you have previously received one from the University of Melbourne or any other institution. Do you declare that you have not previously received a Commonwealth Indigenous Access Scholarship? Select Yes No
7c.  Do you agree to provide the University of Melbourne with personal information relevant to assessing your ongoing eligibility to receive a Commonwealth Scholarship?	Select Yes No
7d.  Do you authorise the University to access Centrelink information on your behalf?	Select Yes No
If yes, please download a Centrelink Consent form and submit it by the date specified in your letter of offer to: The Scholarships Officer, Undergraduate & Graduate Coursework Scholarships Team, Melbourne Scholarships Office, The University of Melbourne, Victoria 3010 If no, please submit a statement, issued by Centrelink, which includes your name and the title of your benefit, dated no earlier than February 2008, that verifies your current receipt of or eligibility to receive Centrelink benefits. Late submissions will not be considered.
7e.  The Minister for Education, Science and Training will issue all new scholarship recipients a commemorative certificate and letter. Do you give your permission for the University to provide DEST with your name, address and scholarship type for this purpose? Select Yes No
Section D - Scholarship Acceptance Survey
Completion of this survey is voluntary; you are not required to complete it to receive your scholarship. However we would appreciate your responses to the following questions for statistical purposes.
1.  Was the University of Melbourne your first choice?	Select Yes No If no, please state your first choice of institution:
2.  Please rank the following statements on a scale of: Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree
	Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
a. The academic reputation of the University of Melbourne was an important factor in choosing a University.
b. The services and amenities offered by the University of Melbourne were an important factor in choosing a University.
3.  Have you changed your course preference since submitting your scholarship application?	Select Yes No If yes, what was your original course preference?
4.  Have you been offered a place at another institution?	Select Yes No Offer pending If yes, please specify Course: Institution:
5.  Have you been offered a scholarship at another institution?	Select Yes No Offer pending If yes, please specify Scholarship: Institution:
6.  Did the offer of a Melbourne Scholarship influence your decision to accept your course place at Melbourne?	----- Select ----- Yes, the offer of a scholarship helped me to decide to accept the course offer No, I would have accepted the course place regardless of the offer of scholarship
7. Are you an interstate student?	Select Yes No
If yes,  Please rank the following statements on a scale of: Strongly Agree, Agree, Neither Agree nor Disagree, Disagree, Strongly Disagree
	Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree
a. Studying at an interstate university was a high priority for me.
b. My decision to accept a scholarship was influenced by the offer of accommodation to a residential college.
8. What factors influenced your decision to accept your scholarship? (maximum 500 characters)
Thank you for taking the time to complete this survey
Date submit:*	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   --Month-- January February March April May June July August September October November December   Year 2007 2008
If you are under 18 years of age, we also require the signature of your parent or guardian. Once you have submitted this form, please print the completed acceptance form, have your parent/guardian sign it and submit it by the date specified in your letter of offer to: The Scholarships Officer, Undergraduate & Graduate Coursework Scholarships Team, Melbourne Scholarships Office, The University of Melbourne, Victoria 3010