Veterans' Children Education Scheme (VCES) - Department of ...

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The information you have provided on this form is required to verify or establish your eligibility for student assistance under theVeterans’ Children Education Scheme (VCES) or the Military Rehabilitation and Compensation Act Education and Training Scheme(MRCAETS). Some of this information may be disclosed to another government agency or organisation for the purposes of:• data matching information;• establishing eligibility for other Australian Government benefits; and• facilitating the student’s education.Giving false or misleading information is a serious offence.How to contact DVAFor information, please call the Department ofVeterans’ Affairs (from anywhere in Australia) on:Callers from regional Australia can call:133 2541800 555 254To contact your local Veterans’ Affairs Network(VAN) Office, please call:If you wish to call DVA in another State, please call:1300 55 19181300 13 1945State Address Postal addressNew South WalesCentennial Plaza Tower B280 Elizabeth StreetSydney NSWGPO Box 9998Sydney NSW 2001VictoriaQueenslandSouth AustraliaWestern AustraliaTasmaniaNorthern TerritoryAustralian Capital Territory300 Latrobe StreetMelbourne VICBank of Queensland Centre259 Queen StreetBrisbane QLDBlackburn House199 Grenfell StreetAdelaide SAAMP Building140 St Georges TerracePerth WABarrack Place254 - 286 Liverpool StreetHobart TASCivic Plaza Building2 Chung Wah TerracePalmerston NTCnr Moore & Rudd StreetsCanberra ACTGPO Box 9998Melbourne VIC 3001GPO Box 9998Brisbane QLD 4001GPO Box 9998Adelaide SA 5001GPO Box 9998Perth WA 6001GPO Box 9998Hobart TAS 7001GPO Box 9998Darwin NT 0801GPO Box 9998Canberra ACT 2601D2566 05/13 P2 of 8
DVA File Number (if known)NOTE:• Read the form through carefully before you start to fill it in.• Answer ALL questions using pen (not pencil).• Mark the appropriate boxes for answers.• Supply ALL documentation as required.SECTION AStudent’s Details1. Student’s full nameTitleSurnameGiven name(s)Mr Mrs Miss Ms Other2. Date of birth3. Home addressPOSTCODE4. Postal address(if same as home address, write ‘AS ABOVE’)POSTCODE5. Term residential address(NOT PO Box) if applicablePOSTCODE6. Work addressPOSTCODE7. Telephone number of school( )8. Contact telephone Home ( ) Work ( )Mobile9. E-mail address10. Is the student engaged in full-timeemployment?NoYes11. Is the student in a partnered relationship?A partner is a person you are married to, ina registered relationship with, or have beenliving with in a de facto relationship.12. Is the student a child or a formerchild of a Vietnam Veteran?NoYesNoYesGo to Section BIs this application being made on the student’s medical grounds?NoYesGo to Section BTo determine eligibility for VCES benefits, DVA may need to obtainrelevant medical and other information about the student from aqualified professional (e.g. medical practitioner, psychologist,social worker). In order to do so, information contained in thisform may neeed to be provided to them - please sign theauthorisation and consent section on the next page.If the student is already seeing a qualified professional (e.g. medical practitioner, psychologist, social worker), please provide the following details:D2566 05/13 P3 of 8
Page 1: Veterans’ Children Education Sche
Page 5 and 6: SECTION EThere are three (3) rates
Page 7 and 8: SECTION H continuedRENT ASSISTANCE2

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