Activate Form

First name

Last name

Email address

Mobile phone

Mentor first name

Mentor last name

Mentor email address

Mentor contact number

Personal statement (450 words)

Why do you want to be part of the Activate Program and what has motivated your choice of subjects? (~150 words)

Describe a time you challenged yourself academically, personally or through an extracurricular activity. What did you learn from the experience? (~150 words)

How would participation in the Activate Program enable you to achieve your future study or career goals? (~150 words)

Additional assessment factors

Please tick any of the following that apply to your personal circumstances:

Current student enrolled at a school on the University Equity Scheme list

Current student enrolled at a school in a regional or rural location

Currently receiving a Centrelink means-tested income support payment

Currently hold a Health Care or Pensioner Concession Card in my own name

Parent/guardian receives a Commonwealth means-tested income support payment

Parent/guardian is the holder of a Health Care or Pensioner Concession Card

Any other factors that may have impacted your academic performance

Adelaide University Activate Program 2027 Application form

Personal statement (450 words)

Additional assessment factors

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