CORE3001 Pilgrimage Application

The information provided in this form will only be used for the administrative or educational purposes of the University, or in accordance with your specific consent. The University will not disclose your personal information to a third party unless required to or permitted by law or where you have consented to the disclosure. Information relating to how the University collects, uses or discloses your personal information and how you may complain about the University’s handling of your personal information is contained in the University’s Privacy Policy.
You have a right to access your personal information that the University holds about you and to seek its correction. If you wish to access your personal information or inquire about the handling of your personal information, please contact Student Administration at student.admin@nd.edu.au

First name*
Middle name
Last name *
Date of birth *	Day Month Year
Gender *
Contact number *
What is your current residency status? *	Australian citizen Other
Have you ever held citizenship or residency rights in Europe? *	Yes, currently Yes, in the past No
Do you have any medical conditions? *	Yes No
Please describe your medical description

Student ID number *
Student email address *
Campus *	Fremantle Sydney Broome
School *
Program name *
Year of study *

Have you completed CORE1000? *	Yes No
Please briefly state why you would like to attend this pilgrimage and what you hope to learn. *	Please write between 300 and 500 words.

I would like to apply for the International Core Grant
For your application of the International Core Grant to be received please ensure you complete this section of the application form and attach supporting documents as PDFs.
How would receiving the International Core Grant enable you to participate in this experience? Please upload or enter here a short personal statement addressing the selection criteria outlined in the Grant Conditions and explain how receiving this Grant to participate in the International Core would benefit you, including any financial or educational situations you feel should be taken into consideration when assessing your application.	Please write no more than 500 words.

Please select all of the means-tested Commonwealth income support payments that you receive.	Youth Allowance Austudy ABSTUDY Disability Support pension Carer Payment or Allowance Parenting Payment Veterans Affairs Payment Pensioner Education Supplement
Which best describes your living situation?
Did you relocate from a regional or remote area of Australia to attend university?	Yes No
Do you identify as an Aboriginal and/or Torres Strait Islander person?	Yes No
Do you have a disability or ongoing medical condition that impacts your studies?	Yes No
Are you currently a carer for another person who needs ongoing support due to a long-term medical condition, a mental illness, a disability, frailty, or the need for palliative care?	Yes No
Are you currently the parent of one or more dependent child under 18?	Yes (single) Yes (partnered) No
Are you the first person in your immediate family (including your parents/guardians and any siblings) to attend university?	Yes No
Have you previously been placed with an out-of-home care (OOHC) provider?	Yes No
Are you, or have you previously been, the holder of an Australian refugee or humanitarian visa?	Yes No

CORE3001 Pilgrimage Elective Application

Personal details

Emergency details

University details

Application details

International Core Grant

International Core Grant supporting documents

International Core Grant conditions

Declaration

Emergency contact name *
Relationship *
Emergency contact phone number *