Student Financial Loans Scheme
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- Miles Butler
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1 Student Financial s Scheme Student Application Form Please ensure all sections are completed clearly in block letters to help us process your application quickly. Please attach all supporting documentation to this application. What sort of loan are you applying for? Educational Support Emergency Expenses Personal Details Student Date of Birth: Student Number: 1: 2: Next of kin You will need to provide full details of two personal referees who may be contacted for checks. Please note that these referees must not be USQ students or staff members. Referee 1 Relationship: Referee 2 Relationship: Finance Office Use Only Wellness Advisor Use Only Finance Number: Assessment Officer: AR to process $ Date sent to Finance: AP to process 61607/652070/2/00 $ Data completed on SharePoint? SS&W/WEL/012/DEC17/Ver3 Page 1
2 Emergency Expenses Only: When cash is received Payment Details Cash Receipt (Toowoomba Only) Cash received from USQ for Emergency use as per the loan contract. Student $Value: Finance Officer Repayment Plan: To be discussed with the s Officer Requested Amount: Period (months) Final Payment Repayments By: Lump Sum Installments Weekly: Fortnightly: Monthly: The University may withhold all or any academic results, grades or awards of the borrower until any outstanding Amount Payable owed under this contract has been paid to the University. I acknowledge that all legal costs or collection fees incurred in recovery of this loan will be my responsibility. The Important Information relating to the USQ Student Financial s Scheme is incorporated into and forms part of the terms of this Agreement. I acknowledge that I have received and understood the Student Financial s Scheme Important Information and I agree to abide by all the terms and conditions of this Agreement. I agree to use the proceeds only for the purposes stated in my Application. I confirm that the information contained in this Agreement is correct and true. Student s Office use only Applicant s Academic Record (GPA)? New Student: Educational Support Textbooks Study Materials Emergency Expenses Study related Travel Computer Food Medical Rent Childcare Outcome Decision: Approved Not Approved If not approved please give brief explanation: (Director, SS&W or nominated delegates) (Director, SS&W or nominated delegates) Total Amount TMBA Emergency Only Bookshop: EFT: Vendor: Cash: Total: SS&W/WEL/012/DEC17/Ver3 Page 2
3 Please tick the appropriate box Full time student Program: Equity Information Part time student Expected Completion: Eg: Sem 2, 2017 Equity Yes No Do you have a disability? Do you come from a rural or remote area? If yes, where? Are you an international student? Are you Aboriginal or Torres Strait Islander? Are you a refugee or migrant? If yes, from where? Do you have dependent children at home? If yes, state their ages. Are you the first in your family to attend university? Information Yes No What is the purpose of this loan? Have you investigated all other sources of financial assistance? If Yes, what sources? What is the cause of your financial hardship? What is your main source of income? Have you previously had a Student Financial s Scheme loan? If Yes, what was the loan for? If Yes, when was it repaid? It is known that students experiencing financial hardship often experience hardship in other areas. Are you currently experiencing hardship in the following areas? Yes No General money management skills / budgeting Employment Balancing study and other demands Study techniques Relationship or family issues Health Gambling Drug, alcohol or tobacco use Risk taking behaviors Decision making Motivation Emotional health e.g. anxiety, depression or stress Being assertive or work issues Asking for help Self-confidence Career direction SS&W/WEL/012/DEC17/Ver3 Page 3
4 Budget Expenses $ Income $ Weekly Fortnightly Weekly Fortnightly Rent / Board Gas Electricity Telephone/ Food Take Away Food Transport (petrol, fares, Health (pharmacy, Incidentals (doctor, dental, Insurance (house, car, health, Entertainment (videos, sports, Clothing Education (textbooks, fees, Childcare/Child Support Youth Allowance Austudy Abstudy Family Allowance Family Tax Benefit Pensioner Education Supplement Disability Pension Newstart Allowance Partner Parents Casual/Part-time Work Employer: Full-time Work Employer: Scholarships (CAS, CECS, USQ, Other (Specify Child Support, etc.) Outstanding s/credit Vehicle registration/maintenance Other (Specify: gifts, subscriptions, TOTAL: $ TOTAL: $ Please provide documentary evidence supporting your income and your expenditure. (For example: bank statements, rental leases, Centrelink income statements, pay slips) SS&W/WEL/012/DEC17/Ver3 Page 4
5 Office use only: Interview Checklist (Assessment Officer) Completed all aspects of the Application form Confirmed Ensure student is aware of the Student Financial Procedures Document and application criteria Two Referees details included USQ loan history checked Meets GPA requirement (N/A for new students - $500 only) Circumstances for the loan application discussed Photocopies of supporting documents attached Photocopy of suitable identification Note criteria discrepancies on application form International Students Is the student government sponsored? Have you made follow up provisions with USQ International where necessary? Y / N Y / N Interview Notes: Office use only: Wellness Advisor Supporting documents attached? Quotes: Income Statements: Bookshop: ID: Other: USQ collects your information for purpose of providing products and services selected by you through your learning journey. To comply with legal and administrative obligations information may be disclosed to Commonwealth and State agencies. Personal information will not be disclosed to third parties other than approved educational services agents, partners or organisations who provides sponsorship to you for your studies. Where we disclose to a third party we endeavour to ensure they are bound by the same requirements as USQ with respect to personal information. Transfer of personal information outside Australia may occur. You have the right to access your personal information and if you wish to inquire about the handling or seek access to your personal information you can contact the USQ Privacy Officer (privacy@usq.edu.au). SS&W/WEL/012/DEC17/Ver3 Page 5
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