Sports Excellence Scholarship Fund Application

SPORTS EXCELLENCE SCHOLARSHIP FUND APPLICATION

This scholarship is available to Victorian school students only. As no late applications will be accepted please take note of the closing dates on this page of the SESF website. https://sesf.org.au/apply/
STUDENT INFORMATION
Sport: *
Age Group *
Full Name: *

First Name Last Name
Date of Birth: *

Month Day Year Date Picker Icon
Gender: *

Male Female
Year of Student: *
Please select the grade of the student, for the year of nomination
PARENT / GUARDIAN INFORMATION
Full Name: *

First Name Last Name
Parent / Guardian E-mail: *
example@example.com
Mobile Number: *
SCHOOL INFORMATION
School Name: *
School Phone Number:
Principals Name: *

First Name Last Name
Principals Email: *
example@example.com

School Address: *

STUDENT SPORTING ACHEIVEMENTS

This information should be filled in by the student and their family
Please advise students sporting acheivements at a Region, State or National level. *
Please explain how the student will benefit from receiving a Scholarship. *
Are there other financial / extenuating circumstances that we should be made aware of? *

PERSON MAKING THE NOMINATION
Full Name: *

First Name Last Name
Email: *
example@example.com
Relationship to Student: *
I agree to the applicant being photographed or filmed, and these images used on websites, and social media channels that may include but not limited to, Facebook, YouTube, Instagram and Twitter, for publicity purposes.
Signature of person making the nomination: (Please use your finger or hold down the mouse button as you move the mouse.) *

PRINCIPAL ENDORSEMENT OF APPLICANT

To learn more about the Sports Excellence Scholarship Fund, please visit the SESF website: www.sesf.org.au

TO BE FILLED IN BY PRINCIPAL
Principal Name: *

First Name Last Name
Principal Signature: (Please use your finger or hold down the mouse button as you move the mouse.) *
As principal please provide a supporting statement for this student, including information on the applicant's financial circumstances. *
eg: Health care card etc...
Does the family possess a health care card? *

Yes No
As Principal, once you have completed this section, please click "Submit" not next.

SCHOOL SPORT VICTORIA OFFICE USE ONLY

This section is only visible in the edit section, and will be answered by the SESF Panel once all the information is received.
Is the application successful? *

Yes No

BANKING DETAILS

The banking details will only be visible to the successful applicants.
Bank Name: *
Eg: Commonwealth, ANZ, BankFirst etc...
Name on the Account: *
Please include the full name on the account details?
BSB Number: *
Account Number: *
Signature: Please use your finger or hold down the mouse button as you move the mouse to create a signature. *
Should be Empty:

SPORTS EXCELLENCE SCHOLARSHIP FUND APPLICATION