I declare that:
1. I have read, understood and met the Terms and conditions of the Award
2. I have not previously been the recipient of the Robert Juniper Award or a Scholarship from the Trust
3. I am currently, or for a significant part of my life have been, associated with the Shire of Mundaring through residence, work or education
4. The information I have given in thhis application is true
5. I have provided relevant, high quality supporting materials via CD, DVD, USB or electronically if unable to do so via this form and have advised The Secretary of the Trust as such
6. If granted an award, I will use the proceeds in accordance with the intentions outlined in this application
7. I understand that the Trust can use my name and image solely for future promotion of the Award.