Scholarship Statement of Support

Must be received by, or uploaded to VTAC by 5pm 11 October 2019

APPLICANT DETAILS
Applicant's Name Rebecca Angela Smith VTAC ID 46658213J

This support statement is being submitted for the following:

Difficult Circumstances
Disability or Medical condition

PERSONAL DETAILS OF THE RESPONSIBLE PERSON PROVIDING THIS STATEMENT OF

SUPPORT

This statement MUST be completed by a responsible person described as follows:

1. A person over 21 years of age

2. A person who is aware of the circumstances of the applicant's claim
3. A person not related by birth, marriage, de facto or other personal relationship
4. A person who does NOT live with the applicant

For further details about providing evidence, please go to www.vtac.edu.au/scholarships/evidence.html

Personal details of the person providing the statement of support:

Name: Year of birth:

Occupation: Employer:
Telephone: Email:

Qualifications relevant to your ability to provide this statement (eg. teacher, doctor, counsellor):
(Statements in support of medical claims should be provided by a health practitioner.)

How do you know the applicant (eg student, patient, client, neighbour)?:
When did you first become aware of the applicant's circumstances?:
STATEMENT OF SUPPORT

In brief, explain what the disadvantage is and the length of time the disadvantage has been
experienced.

In more detail outline the impact of this claim and how these circumstances have impacted on the
applicant's education.

I the undersigned, testify that I have read or had described to me by the applicant the impact of this claim,
and to the best of my knowledge can verify the claim to be true. This Statement of Support provides my
opinion of how these circumstances have impacted on this applicant's education and academic
performance, and their ability to study or deal with daily life.

Signature: Date:
The information submitted on this form is subject to VTAC's privacy policy. Refer to www.vtac.edu.au
for further information.