Postgraduate Study Support Scheme: Application Form for Course Approval

To be completed by applicant

I hereby apply for a 25% rebate of the fees for a full fee-paying, postgraduate course or Associate Student Program subject(s) at Charles Sturt University. I understand that I am bound by the current Academic Regulations of Charles Sturt University.

Staff member’s details

Applicant’s name:
Position:
Division/Section or Faculty/School:
CSU campus or site:
Contact telephone number:
E-mail address:
Staff number:

Eligibility

Are you eligible to apply for the Postgraduate Study Support Scheme? (Refer to clause 4 of the policy.)	Choose an item. If “no”, please do not proceed – your application is unable to be considered.

Course / Associate Student Program details

Name of postgraduate course or Associate Student Program subject(s):

Associate Students – please go to Question 12.

Total number of subjects to be completed in the course (excluding credits):
Does your course involve writing a thesis?	Choose an item. If “yes”, what is the thesis topic?
Course / Associate Program commencement date (month & year):
Expected course / Associate Program completion date (month & year):	Click or tap to enter a date.

Session details

Number of subjects (or thesis) in the coming academic session:	Choose an item. Number: Choose an item. Number:
Total course fees for the session:	$
Start date of session	Click or tap to enter a date.
End date of session:	Click or tap to enter a date.

Benefits

How are the subject(s) in which you are enrolled for the academic session relevant to your current position?

< Enter text here >

How will the subject(s) in which you are enrolled for the academic session enhance your performance/capability for your current position?

< Enter text here >

How will the subject(s) in which you are enrolled for the academic session enhance the capability of your Section/School, Division/Faculty or University?

< Enter text here >

Report

I agree to report on my academic progress and professional development outcomes at performance management meetings.

Choose an item.

If “no”, then this application is unable to be considered.

Applicants Signature:	Date: Click or tap to enter a date.

TO BE COMPLETED BY SUPERVISOR*

*NOTE: If the direct supervisor is employed at HEW level 6 or below, this section should be completed by the manager.

Has this postgraduate course or Associate Student Program subject(s) been negotiated as part of the applicant’s professional development plan in the Performance Management Scheme?

Choose an item.

NOTE: If recommending this postgraduate study for approval of financial assistance, but “no” has been ticked, then please add the course or Associate Student Program subject(s) to the applicant’s professional development plan for the purposes of:

providing the support and resources needed; and

monitoring progress and professional development outcomes.

I Choose an item. this application. Please outline your reasons.

< Enter text here >

Who will be responsible for paying the 75% balance of the course fees?

Choose an item.

Supervisors Signature:	Date: Click or tap to enter a date.

TO BE COMPLETED BY EXECUTIVE DIRECTOR / DEAN / PRIMARY BUDGET CENTRE MANAGER

This application for financial support of postgraduate study is approved / not approved. Please outline your reasons.

< Enter text here >

Signature:	Date: Click or tap to enter a date.

Executive Director / Dean / Primary Budget Centre Manager

Endorsement: Senior Manager, DPC, Organisational Development

Signature:	Date: Click or tap to enter a date.

Senior Manager, DPC, Organisational Development

Postgraduate Study Support Scheme: Applicant’s Checklist

☐	Refer to relevant information in the Policy and Procedure on the Postgraduate Study Support Scheme.

☐	Complete the “Application for Approval Form” (PG1).

☐	Complete the “Residual Benefit Declaration”.

☐	Photocopy your offer of admission.

☐	Discuss your application and submit (a) the completed “Application for Approval Form”, (b) “Residual Benefit Declaration” and (c) a copy of your offer of admission to your supervisor for recommendation for approval.

☐	The supervisor forwards the recommended application (as well as the admission offer and the original residual benefit declaration) to the Executive Director / Dean / primary budget centre manager for approval.

☐	The Executive Director / Dean / primary budget centre manager stores the original application (with recommendation and approval comments) and a copy of the admission offer on file.

☐	The Executive Director / Dean / primary budget centre manager forwards a copy of the approved application and admission offer to the staff member and the staff member’s supervisor.

☐	The Executive Director / Dean / primary budget centre manager forwards a copy of the approved application and admission offer, as well as the original residual benefit declaration, PDPrograms@csu.edu.au.

Privacy Statement

The personal information you provide on this form is protected by the Privacy and Personal Information Protection Act 1998 (NSW).

Provision of this information is a requirement of participation in CSU’s Postgraduate Study Support Scheme for General Staff.

Access to the information you provide is available to yourself, your supervisor, the Executive Director / Dean / primary budget centre manager, and those persons authorised to access the information in the course of their duties to CSU.

This document will be stored within the Division of People and Culture on personnel file.

Residual Benefit Declaration

DECLARATION BY APPLICANT

I,	declare that the cost or part-cost of tuition was provided to me by or on behalf of my employer during the period:

Start date: Click or tap to enter a date.	End date: Click or tap to enter a date.

and that the benefit was used by me for the following purpose:

Self-education which is required to earn a taxable income.

I also declare that, had I purchased the service or privilege, etc for its market value, I would have been entitled to claim an income tax deduction equal to 100% of the purchase price.

I understand that this declaration is to apply to the above stated benefit and to any identical benefit* for a period up to 5 years from the date of this declaration or until the stated percentage incurred in earning my assessable income decreases by more than 10% points. This declaration will also be revoked if another recurring residual benefit declaration is provided in respect of a subsequent identical benefit.

Signature:	Date: Click or tap to enter a date.

*Identical benefits are ones which are the same in all respects except for any differences that are minimal or insignificant, or that relate to the value of the benefits, or that relate to a change in the deductible proportion of 10% points or less.

Submit the completed form to:

Division of People and Culture, PDPrograms@csu.edu.au.

Staff Development – Fee Support If you wish to repay you Charles Sturt loan instalments by direct debit from your salary, please sign and complete this form.

To:	Accounts Receivable finar@csu.edu.au

Division of Financial Services

WAGGA WAGGA

<Enter text here> <Enter text here>

Name:	Charles Sturt University Salary Number:

$<Enter amount>

$<Enter text here> <Enter text here> I authorise Charles Sturt University to deduct the sum of	per fortnight from my salary, for *

fortnights commencing on Click or tap to enter a date. Until my debt of

is repaid in full.

Signature:	Date: Click or tap to enter a date.

<Enter text here>

Tertiary Institution:

*	When calculating the number of fortnights, the final dates for payment will be the last day of the relative session or trimester to which the fees relate.

NOTES

In the event of termination of employment with Charles Sturt University, the amount outstanding will be deducted from your termination pay.

In the event of termination of study, any refund should be applied to any outstanding debt with Charles Sturt University.

If you are studying at an institution other than Charles Sturt University, a cheque will be drawn in favour of that institution and sent to you. It will be your responsibility to forward the cheque and any associated paperwork to that institution for processing.

To commence this process, please return this form to Accounts Receivable in Wagga Wagga, along with a copy of your liability statement.