INDIGENOUS SCHOLARSHIP APPLICATION

Child's First Name *

Child's Surname *

Preferred Name *

Date of Birth *

Birth Certificate and/or Australian passport *

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Aboriginal or Torres Strait Islander Cultural Heritage Certificate *

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Father's Full Name *

Mother's Full Name *

Father's Occupation

Mother's Occupation

Who does the child live with? *

FatherMotherBoth ParentsOther

Full Name *

Relationship to Child *

Child's Residential Address *

Street Address *

City *

State *

Postcode *

Are you applying on behalf of the child and are not the Father or Mother?

YesNo

Full Name *

Relationship to Child *

Contact Phone Number *

Contact Email Address *Email will be the method of contact so please ensure the address is active and correct. Please regularly check your junk mail folder.

School Currently Attending *

Current Year Level at School *

Details of other schools attended, if any:

Details of academic awards, distinctions, prizes, etc..., if any:

Sporting involvement and achievements:

Other cultural, recreational, community activities and interests:

Is there any further information you would like to provide in support of your application?

Recent Full School Report *

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Most recent NAPLAN report *

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Details of referee(s), one of whom should be a community elder:

Referee 1 (Community Elder)

Full Name *

Street address *

City *

State *

Postcode *

Phone Number *

Email Address *

Referee 2

Full Name

Street address

City

State

Postcode

Phone Number

Email Address

Please note the following:

Retain a copy of this application for your records.
Include a copy of a recent full school report.
An interview is an additional requirement of the scholarship selection process.
Applicants not selected for interview will also be notified.

I confirm that I have read and understood Camberwell Grammar School's Privacy Policy. *

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