Year 9 and 10 Experience Scholarship
Application
STUDENT INFORMATION
Name of student
*
First Name
Middle Name
Last Name
PLEASE ATTACH CURRENT PASSPORT STYLE PHOTO
*
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Date of Birth
*
/
Month
/
Day
Year
Date
Current School
*
Current Year Level
*
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PARENT / GUARDIAN INFORMATION
Name and Initial of Parent/Guardian 1:
*
Prefix
First Name
Last Name
Is Parent / Guardian 1 an Old Collegian
*
No
Yes, Class of Year
Email
*
example@example.com
Name and Initial of Parent/GUardian 2:
Prefix
First Name
Last Name
Is Parent / Guardian 2 an Old Collegian
No
Yes, Class of Year
Email
example@example.com
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CONTACT DETAILS
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Mobile
*
-
Area Code
Phone Number
Signature
*
Date
*
/
Month
/
Day
Year
Date
Signature
Date
/
Month
/
Day
Year
Date
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PERSONAL INFORMATION
IS TO BE COMPLETED BY THE STUDENT
ACADEMIC
Do you often get high grades in your school work?
*
If so, which subjects
List your subjects and marks/ grades from your most recent school report:
*
Do you have an idea of a career pathway you would like to follow? Is so, please include and explain why:
*
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LEADERSHIP
Have you held a leadership position?
*
Yes
No
(a) At school, eg. - Prefect, House Captain, Team Captain?
*
b Outside school eg Sports Club Scouts Church Groups
*
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SPORT
Which sports do you play?
*
Have you been in any teams at school?
*
Have you been in any Club (community) teams?
*
Have you gained any certificates, individual trophies or awards in sport?
*
List your most significant sporting achievements.
*
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CITIZENSHIP / INTERESTS
How have you helped your local community
*
Discuss the importance of family
*
Do you learn an instrument play in an orchestra or band or sing in a choir Provide details
*
Do you have any hobbies or interests that you would like to mention
*
Are you looking to board at College
Yes
No
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BOARDING
What attributes could you offer to our Boarding environment?
What do you see as the benefits of Boarding at College?
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ADDITIONAL INFORMATION
Please write 200 words on why you like helping other people and why you would like to be involved in he service learning opportunities at College.
*
Outline any other considerations which you feel to be of importance in supporting your application.
*
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TWO PERSONAL REFEREE CONTACTS
Referee 1: Name
*
First Name
Last Name
Referee 1: Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referee 1: Relationship to applicant
*
Referee 1: Phone
*
-
Area Code
Phone Number
Referee 2: Name
*
First Name
Last Name
Referee 2: Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Referee 2: Relationship to applicant
*
Referee 2: Phone
*
-
Area Code
Phone Number
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FILE UPLOAD
Most recent school report
*
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Second most recent school report
*
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Most recent NAPLAN results
*
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