IVY SCHOLARSHIP APPLICATION
JUNIOR SCHOOL
Student Information
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Name of Student
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First Name
Middle Name
Last Name
Date of Birth
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/
Day
/
Month
Year
Day / Month / Year
Current School
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Current Year Level
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Parent Information
Full Name of Parents / Guardian 1
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Prefix
First Name
Middle Name
Last Name
Full Name of Parents / Guardian 2
Prefix
First Name
Middle Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Mobile Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Is either parent an Old Collegian?
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Yes
No
Signature Parents / Guardian 1
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Signature Parents / Guardian 2
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PERSONAL INFORMATION
This section of the application form IS TO BE COMPLETED BY THE STUDENT
ACADEMIC
Do you often get high grades in your school work?
What are your two favourite subjects and why?
What do you think you would like to be when you leave school?
LEADERSHIP
Have you held a leadership position
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Yes
No
a) At school e.g. Prefect House Captain Team Captain If so please specify
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(b) Outside school, eg. - Sports Club, Scouts, Church Groups? If so, please specify:
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SPORT
Which sports do you play?
Have you been in any teams at school? If so, please list:
Have you been in any Club (Community) teams? If so, please list:
Have you gained any certificates individual trophies or awards in sport? If so, please list:
List your most significant sporting achievements:
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INTERESTS
Do you learn an instrument, play in an orchestra or band, or sing in a choir? If so, please provide details:
Are you part of any groups outside of school? E.g. Art, Minecraft, Lego, Scouts etc.
Do you have any hobbies or interests? Please list and explain what level you are at or what you enjoy about the activity.
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CITIZENSHIP
How have you helped your local community?
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Discuss the importance of family?
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What do you think are three great things about your local community?
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Other
Outline any other considerations which you feel to be of importance in supporting your application.
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PERSONAL REFEREE CONTACTS
(Not family members)
Contact 1:
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daytime contact number:
Please enter a valid phone number.
Relationship to applicant:
Contact 2:
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daytime contact number:
Please enter a valid phone number.
Relationship to applicant:
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