Form

Scholarship Application Form

Application Deadline - January 31, 2019
Read and follow the instructions carefully prior to submitting your application.

Please read the eligibility criteria for the scholarship you are applying for prior to sumitting your application.

All details regarding the scholarship can be found on the Foundation Barossa website.

All applicants must be available for interview in the second week of February 2019.

All applicants will be notified on or before the 7th February, 2019.
If selected, you will be asked for documentation to support the data you provide. Likewise, all correspondence and award agreements will be generated from the personal information submitted below. So, please use proper spelling, capitalisation and punctuation.
Guardian/Parent Consent
By signing (typing your legal name) in the space below, you are certifying that:
- you are the guardian/parent of the applicant
- are over the age of 18
- have given permission for the applicant to apply for this scholarship
- you have assisted the person completing this application
- all information is correct
When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
I have read and understood the instructions. *

Yes, I have
Scholarship applying for:

Kicking Goals Scholarship
Guardian/Parent Full Name *

First Name Last Name
E-mail : *
Where the confirmation will be send to
Guardian/Parent E-Signature: *
I. Applicant Personal Data:

Tell us about yourself
Full Name *

First Name Last Name
Birthdate: *

Day Month Year
Gender:

Male Female Non-specific
Do you have a physical disability?

Yes No
Contact No. :

- Area Code Phone Number

Home Address : *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

BAROSSA CONNECTION
What school will you be attending in 2019? *

Nuriootpa High Faith Lutheran College Kapunda High Gawler and District College Eudunda Area School Immanuel Lutheran College
Status at the time of application: *

I will be in Year 9 at High School in 2019 I will be in Year 10 at High School in 2019 I will be in Year 11 at High School in 2019
What subjects will you be studying next year? Please list all subjects you are enrolled in. *
FINANCIAL INFORMATION
Are you currently receiving or have you previously been awarded an education based scholarship? *

Yes No
If yes, please outline details of the scholarship(s) received
IV. Future plans
The Scholarship is designed to provide some financial assistance for years 11 and 12, together with a mentoring program, focusing on further education and employment. At the end of Year 12, there will be up to $3500 available for the student to spend on further education, educational aids or transport that may be required for future education or employment.

To be eligible for scholarship you must demonstate your aspirations for education or employment when you complete high school.
Are you interested and willing to participate in a mentoring program with John Hughes, the patron of the scholarship program?

Yes No
COVER LETTER
Your cover letter should be 100-250 words. You should address in your letter: your aspirations for the future and what you intend to do with your education or employment following high school, and why a scholarship is important to you. Include any academic and non-academic accomplishments, personal characteristics, or experiences that make you uniquely worthy of scholarship consideration.
Cover letter: *

0/500
V. Applicant's E-Signature
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature: *
Should be Empty:

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Scholarship Application Form

Guardian/Parent Consent

I. Applicant Personal Data:

IV. Future plans

V. Applicant's E-Signature