KnowHQ Low Income Scholarship Application Form
This is the application form for the KnowHQ Fertility Awareness self-paced course. This program is exclusively for low income women & menstruators from Australia. If you do not have an Australian Government Low Income Health Care Card and if you are not an Australian citizen or permanent resident your application will be immediately declined.
Name
*
First Name
Last Name
What are your pronouns?
*
She/her
They/them
He/Him
Rather not say
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Home Address (this is so I can post out some paper charts and a thermometer to you)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you an Australian citizen or permanent resident?
*
Citizen
Permanent resident
Do you have any prior experience with Fertility Awareness?
*
Could you please tell me, in your own words, why you are interested in learning Fertility Awareness?
*
Please upload pictures of both sides of your Low Income Health Care Card
*
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You are encouraged to omit/remove any information on the Health Care Card regarding dependents
Cancel
of
Please provide documentation confirming that your name and address match the details on your Health Care Card (drivers licence, utility bill, phone bill)
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of
I confirm that my information is correct
*
Submit
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