Semester 2 2014
BOOKSHOP GRANT
APPLICATION FORM
Important Note: With regret, we inform applicants that the bookshop grant program this semester has not received the level of
funding that it attracted previously.
As a consequence of this, the number of grants available this semester has been reduced.
Curtin Student Guild allocates money in the form of bookshop equity grants to eligible students (those on a low
income). The grant certificates can only be used at the Co-op Bookshop on Curtin Bently campus (not the Guild
Second hand Bookshop) to purchase essential course related materials
Incomplete, illegible or incorrectly completed applications cannot be considered.
Essential requirements and eligibility:
□ YOU must be an undergraduate student and currently enrolled in a minimum of 50 credits
(please attach current copy of enrolment)
To Qualify You must also answer YES to one of the questions below:
□ Are you in receipt of a means tested Centrelink payment?
□ OR Are you in possession of a Commonwealth Centrelink Concession Card?
□ OR Are you on a low income; meaning an income within $500 of a Centrelink income threshold,
relative to your circumstances (inclusive of international students)?
□ OR Are you living with your parent(s) AND one of your parents is in receipt of a means tested
Centrelink allowance OR your parents combined income is below $45’000 pa?
IF you DO NOT answer YES to one of the above questions – YOU ARE INELIGIBLE to apply for a Bookshop Grant
PART 1: PERSONAL DETAILS
Compulsory Section
First Name
___________________________ Surname _______________________________
Student ID Number ____________________________________________________________________
Address
________________________________________________________________________
Phone
___________________________ Student Email
Course details
________________________________________________________________________
________________________________
 Are you enrolled as an external student AND will you be receiving your books by mail/post from the Curtin University
Bookshop?
YES  NO 
 Have you received a Bookshop Grant anytime in the past 2 semesters?
YES 
NO 
CATEGORIES
Section A – (please choose only one category and complete relevant category on following pages)
To be eligible for a Grant you must fit in to one of the categories in SECTION A and must provide all the
documentation requested to support your application
 Category 1: I am a domestic student who is an independent sole parent caring for at least
one child.
(please provide evidence of your low income and sole parent status, for example Centrelink income statement, copy of Health Care Card,
employment pay slips etc.).
 Category 2: I am a domestic student living with my parent(s)/guardian. My parent(s) and I
earn a low income and I either live with a sole parent or one of my parents receives a
Centrelink payment.
(Please provide evidence of your low income and your parent(s) low income, for example: Centrelink income statements, copy of Health care
Card, employment pay slips etc. You must provide proof of income for yourself and your parent(s). NB: If you receive the full (independent)
rate of Centrelink payment and/or you pay a regular amount for board/lodgings, then you belong in Category 3.
 Category 3: I am a domestic student who lives independently, either on my own, or with my
partner and children (if any), and I/We earn a low income.
(Please provide evidence of your low income and your partner’s low income (if living together), for example Centrelink income statements, copy
of Health Care Card, employment pay slips etc.
 Category 4: I am an International student who lives independently, either on my own, or with
my partner and children (if any), and I/We earn a low income.
(Please provide evidence of your low income and your partner’s low income (if you live with them), via employment payslips or if you are
receiving an allowance –i.e. bank statements, letters from family etc. Please note: In the absence of further information, the default
position will be to assume that your financial circumstances reflect those that are required when applying for Student Visa (Subclass
573) (eg. AUD18 000 per year, for yourself as living expenses).
Please go to the relevant category that is
Applicable to you
Category 1: I am a domestic student who is an independent sole parent caring
for at least one child.
Income:
IF YOU DO NOT PROVIDE COPIES OF ALL THE REQUESTED SUPPORTING DOCUMENTATION YOUR APPLICATION CANNOT BE PROCESSED.
Your Personal Fortnightly Income (net amount after tax) :
Documentation required
Attachment number
Work
$_______________p/fn
(2 most recent payslips)
___________
Centrelink payments
$_______________p/fn
(income statements , etc.)
___________
Scholarships (Non Commonwealth)
$_______________p/fn
(confirmation letter / contract)
___________
Allowance from parents or other significant savings (applicable
to international students)**
$_______________p/fn
(eg. bank statements, highlight
relevant info)
___________
Total of the above
$___________________ p/fn **(If expenses are zero, please provide an explanation)
* Note: ** For Savings and Allowance please calculate the average fortnightly rate based on the Total Amount divided by the number of fortnights this amount will
need to last (do not include any amount set aside only for uni fees)
Expenses
Documentation required

How many children do you care for and who live with
you?
___________________

What is the total number of people in your household
(Self + children)
__________________

Accommodation cost – your share of rent, mortgage
or board
$______________p/fn

Childcare – required childcare for study purposes
$______________p/fn
Total of the above
Attachment number
(Copies of Centrelink statement
OR Health Care Card with names
of dependents listed
_________________
(Copies of rent receipts, lease
agreement, bank/lender
statements and highlight relevant
info)
_________________
(Please provide proof via childcare
receipts - what you pay)
_________________
$ _______________ p/fn **(If expenses are zero, please provide explanation
Please go to Part 2 & 3 at the end of this form
Category 2: I am a domestic student living with my parent(s)/guardian. My parent(s) and I
earn a low income and I either live with a sole parent or one of my parents receives a
Centrelink payment.
Income:
IF YOU DO NOT PROVIDE COPIES OF ALL THE REQUESTED SUPPORTING DOCUMENTATION YOUR APPLICATION CANNOT BE PROCESSED.
Your Personal Fortnightly Income (net amount after tax) :
Documentation required
Attachment number
Work
$_______________p/fn
(2 most recent payslips)
___________
Centrelink payments
$_______________p/fn
(income statements , etc.)
___________
Scholarships (Non Commonwealth)
$_______________p/fn
(confirmation letter / contract)
___________
Allowance from parents or other significant savings (applicable
to international students)**
$_______________p/fn
(eg. bank statements, highlight
relevant info)
___________
Total of the above
$___________________ p/fn **(If expenses are zero, please provide an explanation)
* Note: ** For Savings and Allowance please calculate the average fortnightly rate based on the Total Amount divided by the number of fortnights this amount will
need to last (do not include any amount set aside only for uni fees)
Parents Income:
(You will need to provide income details of parents in the household (net amount after tax)
Income details of Parent One:
Documentation required
Attachment number
Work
$___________________p/fn
(2 most recent payslips)
______________
Centrelink payments
$___________________p/fn
_______________
Other Household Income
$___________________p/fn
(income statements , etc)
(eg. bank statements, highlight
relevant info)
Total fortnightly income
$_____________________ p/fn **If income is zero, please provide an explanation
Income details of Parent Two:
Documentation required
______________
Attachment number
Work
$___________________p/fn
(2 most recent payslips)
______________
Centrelink payments
$___________________p/fn
_______________
Other Household Income
$___________________p/fn
(income statements , etc.)
(eg. bank statements, highlight
relevant info)
Total fortnightly income
$_____________________ p/fn **If income is zero, please provide an explanation
______________
Expenses

How many parents/guardians do you live with?
 1

What is the total number of people in your
household (self + parents + dependent siblings
under the age of 16)
_____________________

Accommodation cost – rent, mortgage paid by
parents
Total of the above
 2
Documentation required
$__________________p/fn
Attachment number
(Copies of Centrelink
statement OR Health Care
Card with names of
dependents listed)
_________________
(Copies of rent receipts, lease
agreement, bank/lender
statements and highlight
relevant info)
_________________
$ _______________ p/fn **(If expenses are zero, please provide explanation)
Please go to Part 2 & 3 at the end of this form
Category 3: I am a domestic student who lives independently, either on my own, or with my
partner and children (if any), and I/We earn a low income.
Income:
IF YOU DO NOT PROVIDE COPIES OF ALL THE REQUESTED SUPPORTING DOCUMENTATION YOUR APPLICATION CANNOT BE PROCESSED.
Your Personal Fortnightly Income (net amount after tax) :
Documentation required
Work
$___________________p/fn
(2 most recent payslips)
___________
Centrelink payments
$___________________p/fn
(income statements , etc.)
___________
(confirmation letter / contract)
Attachment number
___________
Scholarships (Non Commonwealth)
Allowance from parents or other significant savings
(applicable to international students)**
$___________________p/fn
Total fortnightly income
$___________________ p/fn **If income is zero, please provide an explanation
$___________________p/fn
(eg. bank statements, highlight
relevant info)
___________
* Note: ** For Savings and Allowance please calculate the average fortnightly rate based on the Total Amount divided by the number of fortnights this amount will
need to last (do not include any amount set aside only for uni fees)
Partners Income details: (if applicable)
Documentation required
Attachment number
Partner’s Fortnightly Income (net amount after tax) :
Work
$___________________p/fn
(2 most recent payslips)
___________
Centrelink payments
$___________________p/fn
(income statements , etc.)
___________
(confirmation letter / contract)
___________
Scholarships (Non Commonwealth)
Allowance from parents or other significant savings
(applicable to international students)**
$___________________p/fn
Total fortnightly income
$___________________ p/fn **If income is zero, please provide an explanation
$___________________p/fn
(eg. bank statements, highlight
relevant info)
___________
Expenses

Do you live with a partner?
 YES
 NO

If yes, do you and your partner have children that
you care for?
 YES
 NO

If yes, how many dependent children

Accommodation cost – your share of rent, mortgage
or board
$_____________p/fn
(copies of rent receipts, lease
agreement, bank/lender statements
and highlight relevant info)
_______________

Childcare – required childcare for study purposes
$_____________p/fn
(Please provide proof via childcare
receipts- what you pay)
_______________
Total of the above
_____________
Documentation required
(Copies of Centrelink statement or
Health Care Card with the names of
dependents listed)
Attachment number
_______________
$ _______________ p/fn **(If expenses are zero, please provide explanation)
Please go to Part 2 & 3 at the end of this form
Category 4: I am an International student who lives independently, either on my own, or with
my partner and children (if any), and I/We earn a low income.
Income:
IF YOU DO NOT PROVIDE COPIES OF ALL THE REQUESTED SUPPORTING DOCUMENTATION YOUR APPLICATION CANNOT BE PROCESSED.
Your Personal Fortnightly Income (net amount after tax) :
Documentation required
Work
$___________________p/fn
(2 most recent payslips)
___________
Allowance from parents**
$___________________p/fn
(bank statement)
___________
Attachment number
(confirmation letter / contract)
___________
Scholarships
$___________________p/fn
Savings**
$___________________p/fn
Total fortnightly income
$___________________ p/fn **If income is zero, please provide an explanation
(eg. bank statements, highlight
relevant info)
___________
* Note: ** For Savings and Allowance please calculate the average fortnightly rate based on the Total Amount divided by the number of fortnights this amount will
need to last (do not include any amount set aside only for uni fees)
Partners Income details: (if applicable)
Documentation required
Attachment number
Partner’s Fortnightly Income (net amount after tax) :
Work
$___________________p/fn
(2 most recent payslips)
___________
Savings
$___________________p/fn
(income statements , etc.)
___________
(confirmation letter / contract)
(eg. bank statements, highlight
relevant info)
Allowance from parents (applicable to international
students)**
$___________________p/fn
Total fortnightly income
$___________________ p/fn **If income is zero, please provide an explanation
___________
Expenses

Do you live with a partner?
 YES
 NO

If yes, do you and your partner have children
that you care for?
 YES
 NO

If yes, how many dependent children

Accommodation cost – your share of rent,
mortgage or board

Childcare – required childcare for study
purposes
Total of the above
_____________
Documentation required
(Copies of Centrelink statement or
Health Care Card with the names of
dependents listed)
Attachment number
_______________
$_____________p/fn
(copies of rent receipts, lease
agreement, bank/lender statements
and highlight relevant info)
_______________
$_____________p/fn
(Please provide proof via childcare
receipts- what you pay)
_______________
$ _______________ p/fn **(If expenses are zero, please provide explanation)
Please go to Part 2 & 3 at the end of this form
PART 2: please tick any if this is applicable to you!

I am a student who has lived in a regional or remote area of Australia for at least the last 3 yrs and I have had
to relocate to Perth for study.
(please provide a photocopy of a document with your family home address on it, eg. driver’s license)

I am an Aboriginal or Torres Strait Islander student.

I am Permanent Humanitarian Visa Holder.

I am an Australian student from a non-English speaking background (NESB).
(to be considered NESB you must have been born in a non-English speaking country, have permanently moved to Australia less than 10 years
ago and your primary language is not English. (Please provide proof, e.g. migration visa)

I am a student with a temporary or permanent disability and/or medical condition.
(please provide evidence, for example medical documentation/certificate or Centrelink payment description document if you are on Disability
Support Pension.)

I am a student who is a primary carer of an invalid/ disabled family member.
(please provide evidence of Carer payments etc)

I have most recently experienced other extenuating circumstances that have placed me in unforeseen crisis.
(please attach a brief explanation and supporting statement.)
PART 3: Statutory Declaration
Compulsory section
I do sincerely declare that all information supplied by me in this application for a Bookshop Grant is true and correct in every particular. I
agree to the terms and conditions of the Guild’s Bookshop Equity Grants Scheme and understand that even though I may meet the selection
criteria to apply for a grant, I may not necessarily receive one.
This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material particular.

I have attached all relevant supporting documentation required.
Please make sure all relevant documentation is attached before submitting application!
Signature of student___________________________________ Date ______________________
SUBMIT/POST TO:
Curtin Student Guild - Reception
Bldg 106 Curtin University
Kent St Bentley WA 6102
FAX:
08 9266 3384
Note: please allow a minimum of 5 working days prior to the due date.
EMAIL ( pdf format only):
[email protected]
APPLICATION CLOSING DATE:
8th August 2014, 4PM SHARP
RESULTS AVAILABLE: 13th August
In Guild Reception front window
OR
On the Guild Website
All information remains the confidential property of the Student Assist division of Curtin Student Guild