PALLOTTINE ABORIGINAL
 SCHOLARSHIP TRUST

ONLINE APPLICATION FORM FOR 2009 SCHOLARSHIPS

 

             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: *Must not be a member of the scholarship committee

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.

 

YOU ARE REMINDED THAT WITH THIS APPLICATION YOU MUST MAIL OR FAX:

Your results from the semesters of study you completed in 2008
You must undertake to send to the committee your results for the last semester of 2008 before the 15th January 2009

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

 

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: Type Name

Date: Place:

 

 

Pallottine Aboriginal Scholarship Trust
60 Fifth Ave
Rossmoyne  WA   6148

Phone:  08 9354 0208
Fax:      08 9457 0344
Email:  pallcomm@wn.com.au  

 

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