Special Circumstances Form
Contact number:
Student ID:
Name of Scholarships/Grants:
There may be circumstances beyond the student’s control that have an impact on a student’s
ability to meet the eligibility criteria of this scholarship/grant. The CSU Scholarships Office will
take into account these circumstance when assessing your application.
PLEASE NOTE: You only need to fill out the relevant field/s that relate to your circumstances:



Explain in detail your circumstances.
If there is not enough room in the fields below please attach a separate page.
Make sure you provide evidence where possible to support your statement, for example:
medical certificates, disability statement, statements from course coordinators,
counsellors letter, legal documents, police reports etc.
All criteria for your scholarship/grant can be found in the relevant guidelines on the CSU
website.
 Part-Time Enrolment:
If your scholarship guidelines state you must be a full-time student and you are only studying parttime, please explain why you are studying part-time:
 Distance Education Subjects:
If your scholarship guidelines state you must be enrolled internally for the majority of your subjects
and you do not meet this requirement, please explain why you have to study those subjects via
distance education:
Did you discuss your study load or change of study mode with your Course Coordinator?
If NO, please explain why. If YES, what advice did they give?
Special Circumstances Form
 Grade Point Average (GPA):
If your scholarship guidelines state you must maintain a certain GPA level and you are not meeting
this requirement, please explain why your GPA is below the required level:
 Other Circumstances:
If there are special circumstances that are not covered in the above fields please explain your
situation below:
Please tick the boxes to indicate you have read and understood the Privacy Statement,
completed the form correctly and attached all required documents.
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).
If it is determined that false or misleading information has been provided your
application will not be considered.
I have attached the required supporting documentation.
Student signature:
Date:
This form can be EITHER emailed to: [email protected]
OR mailed to: CSU Scholarships Office, Student Services, PO Box 789, ALBURY, NSW 2640.