APPLICATION FOR AN INDIGENOUS STUDENT SCHOLARSHIP

First Name *

Surname *

Date of Birth *

Father Full Name *

Mother Full Name *

Father's Occupation

Mother's Occupation

Address *

Street address *

City *

State *

Postcode *

Contact Email Address *

Contact Telephone Number *

School Currently Attended *

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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Names of referees, one of whom should be a community elder

Referee 1

Full Name (Referee 1) *

Address (Referee 1) *

Street address *

City *

State *

Postcode *

Telephone (Referee 1) *

Email Address (Referee 1) *

Referee 2

Full Name (Referee 2)

Address (Referee 2)

Street address

City

State

Postcode

Telephone Number (Referee 2)

Email Address (Referee 2)

Signature of Father

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Signature of Mother

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Date

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.

PRIVACY ACT NOTICE

The personal information on the following pages is collected by Camberwell Grammar School in order to process an application for a Scholarship. This information is used to assess an applicant’s suitability for a scholarship, aswell as to give the school the ability to contact you for the purposes of disseminating information regarding the school and the scholarship. If we do not obtain this information we will not be able to process the application.The information provided on this form will be used by the school to contact those families who are to be invited for an interview and to whom an initial offer of a scholarship may be made. The information will be kept by Camberwell Grammar School until the end of the year in which the applications are submitted, at which time it will be destroyed or permanently de-identified. Parents may seek access to the information by contacting Camberwell Grammar School on 9835 1777. All information remains confidential and will not be used for anyother purposes

I confirm that I have read and understood Camberwell Grammar School's conditions as well as the Privacy Notice. *

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