Form Sy101.1411 - Verification Of Campus - Australia Government - Department Of Human Services
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1
2Verification of Campus
2
Purpose of this form
Campus details
Please provide details of the institution(s) and campus you are
To verify your place of study to assess your eligibility for Relocation
attending. If you are studying at two campus(es) you need to
Scholarship. If you do not provide evidence that you are attending
provide details of both campus(es).
a regional campus you may not qualify for Relocation Scholarship.
For more information, go to our website
2a – Campus 1
www.
humanservices.gov.au/relocationscholarship
Name of educational institution (e.g. university name)
Who should fill in this form
Campus location (i.e. address of physical location you attend)
PART A – (Questions 1 to 4) – to be completed by the student.
PART B – (Question 6) – to be completed by an authorised officer
at the campus(es) you attend.
Postcode
Returning your form
Period of enrolment at this campus
Check that all questions are answered and the authorised officer
has signed and dated this form at PART B – question 6.
From
To
Please make sure that the authorised officer has placed their
/
/
/
/
institution’s official stamp in the space provided at PART B –
question 6.
2b – Campus 2 (if applicable)
Name of educational institution (e.g. university name)
You can return your completed document(s) by:
• going to myGov website, signing into your account and
selecting Centrelink Services. You can upload your evidence
Campus location (i.e. address of physical location you attend)
by selecting ‘Documents and Statements’ from the menu.
If you do not have myGov account, you need to create one
first and link to Centrelink.
• if using one of our Express Plus mobile apps, select ‘Upload
documents’ from the menu.
Postcode
Period of enrolment at this campus
PART A – to be completed by the student
From
To
1
Your details
/
/
/
/
Family name
Go to 3
First given name
Second given name
Date of birth
/
/
Student Identification Number
CLK0SY101 1411
SY101.1411
1 of 2
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