OS Help Loan Application Form: SSC – April 2015 1. STUDENT DETAILS STUDENT NUMBER PHONE NUMBER SURNAME/ GIVEN NAMES FAMILY NAME MAJOR/ COURSE TITLE MINOR COURSE DURATION (SEMESTERS) 2. EXPECTED COMPLETION SEMESTER OS HELP LOAN REQUEST Have you received an OS-Help loan before from ECU or another provider? Yes No Select the loan type and amount you wish to apply for (Please note students are only eligible for one loan per six month period). MAXIMUM OTHER AMOUNT (PLEASE SPECIFY) OS-HELP ASIAN DESTINATION $7635 Other amount $ OS-HELP NON-ASIAN DESTINATION $6362 Other amount $ Do you wish to apply for the supplementary Asian language study loan of $1018 to prepare for study in Asia? Note this preparatory study cannot be counted towards your ECU degree. Yes No Which Asian language(s) do you intend to undertake in preparation for your study overseas? 3. BANK DETAILS Bank Name: Bank Branch: BSB: Account Number: 4. OVERSEAS STUDY DETAILS Are you applying to study overseas as: An exchange student? A student who has been nominated to study at either an official ECU exchange partner university or another that they have selected for either a semester or full year placement. Complete sections 5 and 7 and return the completed form to Student Central A non-exchange student? A student who has been approved by their Faculty to take short-term or session/yearlong study, fieldwork or a professional placement (internship, clinical elective, etc) overseas which will count towards a course requirement for their ECU degree. Complete sections 6 and 7 and return the completed form to your Faculty Student Information Office 5. EXCHANGE STUDENTS ONLY – EXCHANGE PLACEMENT DETAILS YEAR OF TEACHING PERIOD OVERSEAS COMMENCEMENT DURATION OF STUDY One semester Two semesters NOMINATED DESTINATION - COUNTRY NOMINATED HOST UNIVERSITY 6. NON-EXCHANGE STUDENTS OVERSEAS STUDY DETAILS (STUDY TOURS, INTERNSHIP, PROFESSIONAL PLACEMENTS ETC.) Study tour START DATE Other short term program (professional placement/Internship etc.) END DATE DURATION IN WEEKS NAME OF UNIVERSITY/ ORGANIZATION (IF APPLICABLE) ECU UNITS AWARDED FROM OVERSEAS STUDY UNIT CODE UNIT NAME ECU CREDIT VALUE TOTAL CREDIT(S) TO BE GRANTED TO ECU COURSE 7. APPLICANT DECLARATION I declare that the information supplied by me in this application is complete, true and correct in every particular and that I have not withheld any relevant information. I consent to receiving electronic communication in relation to the OS-HELP application, as required. I understand that the information contained in this form is collected for the purpose of determining my entitlement to OS-HELP assistance. If I provide false or misleading information in applications for OS-HELP, I understand that the University may be required to disclose information contained in this form to the Australian Government. ECU may also be required to disclose my personal information as otherwise authorised or required by Law. I agree to abide by the conditions on the OS-HELP Loan Scheme, which may be amended from time to time. I authorise the university to enrol me in approved study tour unit(s) (Exchange student will be enrolled as part of your application process). STUDENT’S SIGNATURE DATE STUDENT NUMBER OFFICE USE ONLY A. COURSE COORDINATOR TO COMPLETE FOR NON-EXCHANGE STUDENTS If this study is in Asia, do you support for the intensive Asian language(s) preparatory training indicated in section 2 Yes No Do you approve the units for credit as listed in section 6? Yes No ANY ADDITIONAL COMMENTS COURSE COORDINATOR/ STUDY TOUR LEADER SCHOOL COORDINATOR’S SIGNATURE DATE RETURN FORM TO FSIO B. FACULTY STUDENT INFORMATION OFFICE TO COMPLETE Does the credit approved by the course coordinator/study tour leader fit into the student’s course structure? FSIO’S SIGNATURE Yes No RETURN FORM TO STUDENT CENTRAL DATE C. STUDENT CENTRAL TO COMPLETE Australian citizen or humanitarian visa holder ≥ 15 credit points to complete after overseas study Commonwealth supported Course credit approval sighted Has completed 120 credit points- prior to commencement of overseas study Student will be full time during the overseas study Enrolment approved at overseas institution (exchange students only) Applicable unit/s enrolled APPLICATION OUTCOME Approved Forward to scholarships via RN Provisional Approval To be reassessed; advise student Not Approved Advise student COMMENTS SC’S SIGNATURE DATE
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