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The Country Women's Association of Victoria Inc. 3 Lansell Road, TOORAK VIC 3142 APPLICATION FORM FOR SPECIAL EDUCATIONAL GRANTS AND AWARDS THREE References are required: TWO from responsible citizens, ONE from Year Level Co-ordinator Applications will not be considered if these are not supplied. ALL questions must be answered. Applications must be received in this office before due date in any year. Late entries will NOT be accepted. The Applicant/Mother/Legal Guardian of applicant, must have been a member of the CWA of Victoria for at least 18 months. CWA Branch to which Applicant/Mother/Legal Guardian belongs........................................................... Length of Membership.................................. No of branch meetings attended during year....................... 1. PERSONAL PARTICULARS Name of Applicant:............................................................................................................................ Family name (block letters) Other names Home Address: ............................................................................................................................ ............................................................................................................................ Post Code.................................................. Contact Telephone No: (....... )..................................... Date & Year of Birth:............................ Are any Bursaries or Scholarships held? Yes No If YES give particulars............................................................................................................................ What CWA Special Educational Grants and/or Awards are being applied for?......................................... …………………………………………………………………………………………………………………………….. What other Scholarships are held or being applied for?..................................................................................... 2. FAMILY INFORMATION: Name of Parents................................................................................................................................ (or Legal Guardian) (Father) (Mother) Are both parents living? Yes No If NO - State which is deceased...... Mother / Father.... Is either parent an invalid?........................ Yes ...... No ...................................................... Present occupation of Father.............................................................................................................. Present occupation of Mother............................................................................................................. Present occupation of Legal Guardian................................................................................................. Number & Ages of other dependent children in family......................................................................... ................................................................................................................................................................... 3. EDUCATIONAL INFORMATION: School attended................................................................................................................................. Standard reached............................................................................................................................... Date last attended.............................................................................................................................. State chosen course of study.............................................................................................................. Where to be taken............................................................................................................................. Any additional information which applicant may desire to present may be given on a separate sheet. ................................................................................................................... ........................................... SIGNATURE OF APPLICANT DATE ................................................................................................................... ........................................... SIGNATURE OF BRANCH PRESIDENT DATE ................................................................................................................... ........................................... SIGNATURE OF GROUP PRESIDENT DATE
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