EmailMe Form - Destination Australia Cheung Kong Exchange Program

Name *

First Last

Student number *

Gender *

Date of Birth *

DD / MM / YYYY

Please note preference is given to students aged 18 to 30 years of age as at 1 January 2024 for non-Indigenous applicants and

Mobile phone number *

Email *

Which city do you live in? *

Which degree are you studying at CDU? *

Are you of Aboriginal and/or Torres Strait Islander origin? *

Are you an Australian Citizen? *

If 'Yes', do you have a dual citizenship, permanent residency or similar in another country?

Country of dual-citizenship

Assessment criteria

Please answer the questions below (200 words approx.)

(1) Why do you want to study abroad and what do you hope to accomplish from this experience?

(2) How will this scholarship assist this goal? *

Which country would you like to travel to? *

My application has been endorsed by Course Coordinator (upload signed form) *

Yes

No

Approval from Course Coordinator - Signed Form

Declaration and consent

I declare that the information I have supplied on this form and in associated attachments is complete, true and correct, to the best of my knowledge. I understand that if any information is found to be incorrect, my application may be cancelled.

I give my consent to Charles Darwin University to use and/or disclose my application and all supporting documents to the funding provider for the purpose of shortlisting and selection.

Signature *

Clear

Date Time *

DD / MM / YYYY