CSU EQUITY SCHOLARSHIPS AND GRANTS
FINANCIAL HARDSHIP FORM
STOP! Only complete the personal statement below if you are not in receipt of an eligible
means tested Centrelink Benefit. For more information on Centrelink Benefits, go to the Centrelink
website.
CSU Student Number:
Last name:
First names:
Course:
Campus:
Name of Scholarships/Grants:
I am over 22 years of age
I am under 22 years of age
Please note that if you are under 22 years of age you are considered to be a dependent on your
parents/guardian. You will need to attach a copy of their ATO notice of Assessment and a current
pay slip. If you consider yourself independent you need to supply the following documents

Current pay slip with year to date earnings

Financial budget showing how you financially support yourself

Recent utility bill / Lease agreement showing residential address
PERSONAL STATEMENT
1. Please explain why you are not eligible to receive an eligible means-tested Centrelink Benefit. If
you require further space please attach a separate statement.
Yes
No
2. Are you in receipt of Family Tax Benefit A or B (FTB)? (If YES, please attach a
copy of the FTB Centrelink statement)
3. Are you in receipt of a Centrelink Health Care Card (HCC)? (If Yes, please attach a
copy of your HCC)
4. Are you living at home with your parent/s or Guardian? (If Yes, please attach a
copy of their most recent ATO notice of assessment)
5. If yes to question 4, how many dependent/s are your parents supporting? No.
CSU Equity Scholarships and Grants Exceptional Financial Hardship Form 2016
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CSU EQUITY SCHOLARSHIPS AND GRANTS
FINANCIAL HARDSHIP FORM
Yes
No
6. Are you residing in on campus accommodation?
7. Are you living at home with your Partner / Defacto? (If Yes, please attach copy of
their most recent ATO notice of assessment)
8. Do you have any dependents? (including adults or children not indicated above)
9. If you answered yes to Q8, how many dependents do you have and what is their
relationship to you?
10. Are you currently employed or have you been employed in the previous 6 months?
(If yes please attach a copy of your most recent ATO notice of assessment
and your most recent pay slip)
Applications that do not have supporting documentation will not be assessed
Documentation required (it is compulsory to provide supporting documentation)
You must provide the following documents as applicable to you please tick what you have included:
FTB Centrelink Statement
Health Care Card
A copy of my ATO Notice of Assessment
A copy of my Partners ATO Notice of Assessment
A copy of my Parents ATO Notice of Assessment
A copy of my most recent payslip showing YTD earnings
A copy of my Financial Budget
A Financial Budget
A recent Utility bill / Lease Agreement
Please provide any other documentation to support your application for financial hardship.
Please tick the boxes to indicate you have read and understood the Financial Hardship
requirements for your scholarship/grant.
I certify that I have read and understand the Privacy Statement.
I acknowledge that I have read the relevant scholarship/grant guidelines
I certify that the information supplied on this form and in the accompanying documents is
complete, true and correct
I understand that giving false or misleading information is a serious offence under the
Criminal Code (Commonwealth).
I have attached the required supporting documentation
If it is determined that false or misleading information has been provided your application
will not be considered.
Student signature
Date
This form can be emailed to: [email protected]
CSU Equity Scholarships and Grants Exceptional Financial Hardship Form 2016
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