DAVID WILLIAMS FUND ABN VAC: 52 907 644 835 CONFIDENTIAL ABN GMHC: 87 652 472 253

SUBSEQUENT

APPLICATION FOR STUDY ASSIST 2026

The David Williams Fund provides support to improve the well-being of the Victorian HIV community. Not all applications are approved as demand on the fund is high.

The DWF Study Assist project accepts applications for: Enrolment Fees, books, Course equipment, and other relevant needs for further education

The fund cannot provide: HEX, HELP or VET debts, University loans, late fees from Libraries, fees / items already paid

The checklist on the back of this form will assist you to complete the application correctly. It may be to your advantage to access a community /social worker, to assist with your application.

Interviews: you may be required to attend an interview with the DWF coordinator to determine suitability. Entry requirements must be researched by the applicant and not the DWF’s responsibility.

All applications must be lodged by 4.00 pm Friday to 51 Commercial Rd South Yarra 3141. All applicants are advised of the outcome by email or phone during the following week.

As a publicly funded organisation we are bound by the Victorian privacy laws - the Information Privacy Act 2000 and the Health Records Act 2001 - as well as other laws which impose specific obligations on us in regard to handling information. Files are shredded if not used for seven years.

Legal Name*:
Preferred Name:
Address:
Postal add (if diff)
Date of Birth*:	Centrelink CRN:
Phone number:
Email address:
*Mandatory fields OR details via THH client file	
Case Worker Details (if applicable):
Name:	Phone:
Organisation:
How did you hear about Study Assist?
If you do not want mail sent, please mark this box:	

Course / University / Tafe Information

Name of Course:
Which education institution is your course at?

Is the course you are applying for accredited?	Yes		No	
If no, the DWF may not be able to assist, please check for accredited courses.
Are you applying for 1st year?	Yes		No	
If yes:
Have you attached confirmation verifying acceptance to the course?	Yes		No	
Are you applying for continuing study?	Yes		No	
If yes:
Have you attached verification / end of year reports, showing what you have already completed?	Yes		No	

Other Scholarships

Have you applied for any other scholarships / grants?	Yes		No	

If so, where and what was the outcome?

Please note, you may also be required to apply for other scholarship / funding sources along with requesting our funding. It is advisable to have an interview with the David Williams Fund coordinator to ensure all options are open.

Request For Study Assistance

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Item and payment information
Please note you may request multiple items but there is no guarantee that these will be granted. Please prioritise your requests. You may include study materials / fees / books and items related to your area of study. All cheques are to be made out directly to the TAFE / University / College or bookshops. Payments will not be made into your account.
Item:	Amount $:	Payable to:
1
2
3
Please eMAIL me the outcome		Please call me with the outcome	

Supporting Statement (required)
Please document below what you want to study and how it will improve your health / wellbeing and/or chances of employment. Please detail why you want to do this particular course of study. Attach a separate piece of paper if necessary: THIS PART IS MUST BE COMPLETED FOR THE APPLICATION TO BE PROCCESSED

Client Consent Statement
I authorise the DWF to seek verification if and where necessary to confirm any information provided in this application or any applications I may make in the future. I certify that all the information provided is true and correct. I agree that the DWF may share and exchange information in order to assist in resolving my financial difficulties with other agencies / companies directly involved, for the purpose of providing me with the best possible support to suit my circumstances. I understand that relevant information about me will only be shared when deemed necessary or to progress my case or application and consent to my name, address and phone number being given to the DWF supplier. I certify that all the information provided is correct and true.
Client signature:	Date:
If prepared by Case Worker on the Client’s behalf:
Case worker’s name:	Phone:
Signature:	Date:

CHECKLIST

Please tick the appropriate boxes

If you haven’t attached the appropriate documentation your application will be delayed until the documentation has been provided

I have attached verification of my health status, from my doctor – All registration documents must be originals, not faxed or photocopies.

I have attached a current copy of my Centrelink Health care card

I have attached a copy of Centrelink income statement or I have signed authority for the Fund to obtain one

I have attached a copy of the course enrolment form, acceptance and invoice

I have attached information of other scholarships / grants if applicable

I have attended an interview with the David Williams Fund coordinator.

I have attached any other relevant information to enhance my application

If you wish the committee to reconsider your application because of special circumstances or if you are not satisfied with some aspect of the DWF process, you must put it in writing and forward it to the DWF committee.