PLEASE NOTE AN NT GOVERNMENT STUDENT ASSISTANCE APPLICATION MUST
PLEASE PRINT THIS FORM AND TAKE A COPY TOX PLEASE COMPLETE THE REQUIRED INFORMATION IN ADDITION THE
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ACC 4152 IMPAIRMENT ASSESSMENT (ACCREDITED EMPLOYER) REPORT PLEASE
Associate Application Form (please Print and Complete
BLACK HISTORY MONTH 2007 EVALUATION FORM PLEASE
NT Remote Area Travel Allowance claim form
Please note: An NT Government Student Assistance Application MUST be submitted, prior to a claim being accepted. The application form is available on the Department Website at www.education.nt.gov.au/grants/funding/general/sas. If you cannot download an application form, please contact the Finance Student Assistance Officer as noted below.
Financial Services -
Student Assistance - GPO Box 4821, DARWIN NT 0801 Tel:
(08) 8901 4965 Free
call: 1800 019
157 Email:
[email protected]
20____
NT REMOTE AREA TRAVEL Student
Names:
Name
of claimant (1) ……………………………………………..... Name
of claimant (2) …………..………………………………..................... Home
address……………………………………………................ Postal
address …….………………………………………............................
State
.............................................Postcode
............................................. State
.............................................Postcode
............................................ Email
address
……….……………………………….......................................................................................................................................................... Home
ph
.......................................................................Work
ph …………….........................................
Mobile…….……………………………..............
PRIVATE
VEHICLE DETAILS Vehicle
Type……………………………………..Registration
No………………………………….......
Date……………… From………………………………………… To.………………………………………. kms
(each way)………….........
Date……………… From………………………………………… To.………………………………………. kms
(each way)…………….....
Date……………… From………………………………………… To.………………………………………. kms
(each way)………….........
Date……………… From………………………………………… To.………………………………………. kms
(each way)……………......
Date……………… From………………………………………… To.………………………………………. kms
(each way)……………......
Date……………… From………………………………………… To.………………………………………. kms
(each way)…....................
Date……………… From………………………………………… To.………………………………………. kms
(each way)…………….......
Date……………… From………………………………………… To.………………………………………. kms
(each way)………..............
I
certify that the student was boarding at the time travel was
undertaken and that the details listed on this form are a true
record of distance travelled in respect of my claim for the NT
Remote Area Travel Scheme, that all journeys claimed were
undertaken by private vehicle,
to convey the students from their principal place of residence to
the centre where the boarding institution is located.
Signature
of claimant (1) ……………………………………………………….... Date
……………………………………………………………………...... Signature
of claimant (2) …………………………………………………………. Date
……………………………………………………………………..... Example
given:
From:
- The students Principal Place of Residence. To:
- The nearest centre from which interstate transport is available. Then
parents return trip is: From:
- The
nearest centre from which interstate transport is available. To:-
The
students Principal Place of Residence.
$
…………...... $
…………...... $
…………...... $
…………......
Date……………… From………………………………………… To.………………………………………………….
Date……………… From………………………………………… To.………………………………………………… Date……………… From………………………………………… To.…………………………………………………
Date……………… From………………………………………… To.………………………………………………… $
Attach
all ticket receipts and boarding passes.
The
above student/s is/are enrolled at.……………..………………………………………….School
and attended /s regularly. Signature
of Principal /
Registrar……...…………………………………………. Date.…………….……………………………….
STAMP
OF SCHOOL / INSTITUTION
DETAILS
OF TRAVEL BY PRIVATE VEHICLE
COST
Total
of Tickets
DETAILS
OF STUDENTS TRAVEL BY BUS, RAIL OR AIR TO THE POINT OF PICK UP
CERTIFICATION
BY SCHOOL PRINCIPAL / REGISTRAR
CLIENT DETAILS FORM PLEASE COMPLETE THE INFORMATION
CREDIT APPLICATION – TRANSMISSION A PLEASE REFERENCE
DATE PLEASE FILL IN TO THE
Tags: application must, an application, student, assistance, application, please, government
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