PALLOTTINE ABORIGINAL
 SCHOLARSHIP TRUST

APPLICATION FORM FOR 2013 SCHOLARSHIPS

PRINT & POST

           Title     First            Middle             Family
NAME:                             

Date of Birth:             

Place of Birth:           

Are you an Aboriginal or
Torres Strait Islander Person     (Please tick)    Yes  No 

Permanent Address: 

Postal Address:          

Telephone:   

Fax:              

E-mail:          

Current place of employment
or schooling:             

Last school attended:

Year last attended:    

Standard attained:    

Any other courses completed:
          Year:              Place:                 Name of course: 

Course you intend to study:

Nominate the institution where
you intend to study:

Please nominate two people
to act as referees:

1. Name:  

Address:  

Telephone: Home  

Work:                    

2. Name:  

Address:   

Telephone: Home   

Work:                  

 

Name any community or Aboriginal organization
in which you are or have been involved.

(Please tick)

At present on whom do you
depend for support?                Self  Family  Other

If other, please specify: 

If you obtain this scholarship
who will support you?               Self  Family  Other

If other, please specify: 

Have you ever received a scholarship?                                                              Yes     No 

If yes, please specify:    

Have you current applications
for other scholarships?                          Yes     No 

If yes, please specify:     

 

In the space provided below, please indicate to the Scholarship Committee

  • your areas of career interest.
  • how might the Aboriginal community benefit if you received this scholarship?
  • you may also wish to comment on why you have chosen a particular course.
  • your future goals.
  • the length is determined by what you wish to outline to the Scholarship Committee, but we would suggest about 250 - 300 words. You may attach additional pages.

 

I declare that this Application for the Pallottine Aboriginal Scholarship is my own work and that all information provided is, to the best of my knowledge, true and accurate.

Signature of Applicant: 

Date:   Place:  

 

 

YOU ARE REMINDED THAT WITH THIS APPLICATION YOU MUST MAIL

Your results from the semesters of study you completed in 2012
You must undertake to send to the committee your results for the last semester of 2012 before the 15th January 2013

Applications will be called for each year. They close on the 30th of September.

POST TO

Pallottine Aboriginal Scholarship Trust
c/- Pallottine Regional House
45 Ionic St
Shelley  WA   6148

Phone:  08 9354 4061
Email:    ray.h@pallottine.org.au

 

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