YI CE.CHANCELLOR'S SCHOLARS H I PQOUniversity Australia is pleased to offer the opportunity t0 apply for a C0University Vice-Chancellor's Scholarship.All successful candidates will be notified of the outcome in writing priorto their commencement date.Please note: applications should be directed to the relevant C0University campus. The addresses are listed on thereverse of this form.

Refer to terms and conditions section for further information.

Please type or write in BLoCK letters using a BIICK pen.

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Date of birth (DD/MM/YY)Student humber (if known)

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Surname/family name

Country

Mobile number

Email address

Country of citizenship as shown in your passport

Passportnumber

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Which C0University campus are you applying to?

Documentary evidence must be provided.

COUniversitywill select recipients based on prior academic achievement as reflected by information in the completed Application for Admission.This irprmation may include, but is not limited to, results and class standingr---7lV I I have attached evidence ol my graded transcripts showing my completion of studies

Please note all supporting documents submitted must be certified or original documents.

I declare the information supplied by me on this form and all attachments is complete, true and correct in every particular.

I authorise C0Universityto obtain from other educational institutions and relevant authorities details of my enrolment, academic record, examinationresults and bond status.

o,tu[7T7 la;TAIWApplicant's signature

(DD/MM/YY}