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The Country Women’s Association of Victoria Inc. A 000485F ABN 55 584 949 677 APPLICATION FOR AA GIBBS FOR SECONDARY AND TERTIARY EDUCATION GRANTS(Awarded in December 2012) Educational Grants awarded for one year only Only one Educational Grant awarded per family in any one year FOUR Secondary and FOUR Tertiary when available THREE References must be supplied: TWO from responsible non-family citizens and ONE from Principal/Co-ordinator Current references must be supplied each year, or the Application will not be considered Applications must be received at CWA Head Office, 3 Lansell Rd, Toorak 3142 by 30 September 2012 Late entries will NOT be accepted This Form may be photocopied. Information and Application Forms also available on the website: www.cwaofvic.asn.au Membership qualifications: the Applicant or Mother/Legal Guardian or Grandparent must be a Member of CWA of Vic Inc of at least eighteen (18) months standing Note: Any money received from The Country Women’s Association Scholarship Fund is non-taxable income for the recipient ALL QUESTIONS MUST BE ANSWERED (Block letters please) 1. PERSONAL PARTICULARS Family Name of Applicant ………………………………………………………………... Given Names …......................................................……....……………………………….. Home Address …………………………………………………………………………………………………………………….. Postcode …………………………………………... Contact Phone Number …………………………… Date of Birth ……………….............……………... Is the Applicant applying for a scholarship for the first time? Yes [ ] No [ ] Other Scholarships a. Held……………………………………………………………… b. To be applied for……………………………………………….... 2. EDUCATIONAL INFORMATION School attended in current year ……………………………….……...…. Year Level …… Results for current year ………………….. School/University to be attended next year …………………………………………………………… If tertiary, course to be studied and intended career ………………………………………………………………………... 3. FAMILY INFORMATION Names of Parents/Legal Guardians ……………………………………………………………………………………………. Present occupation of Parents/Legal Guardians …………….…………………………………………………………………. ………………………………………………………………………………………………………………………………….. Number of dependent children in family [ ] Ages [ ] [ ] [ ] [ ] [ ] [ ] [ ] CWA Branch to which Grandmother/Mother/Legal Guardian belongs (if applicable) .......................…..…………………..... Length of Membership …………………….. Date joined ……............. Number of meetings attended in past 12 months ……….. Is Applicant a Junior Member in own right? Yes [ ] No [ ] If Yes: Branch ………………………………………….. Are other family members receiving Higher Education? Yes [ ] No [ ] Secondary – Yes [ ] ………………………………………………………………………... Tertiary – Yes [ ] (Where?) ……………….……………………………………………… Are other family members holding other scholarships? Yes [ ] No [ ] If Yes: (Name/s) ……………………………………………………… (Where?) ………………………………………………………...……. (Value) $ …….…. 4. GENERAL INFORMATION (Please use a separate sheet) All information is strictly confidential (To be completed by Grandparent/Parent/Legal Guardian of Applicant) State fully the reasons for your application for an Educational Grant Give any additional information or special circumstances, which may be of assistance to the Scholarship Committee The Group President must sign the completed Application Form after checking all details Signature of Parent/Legal Guardian ..............................................................…… Date ………………… Signature of Applicant …………………………………………….……………… Date ………………… Signature of Branch President ...................................................................….…... Date …………...……. Signature of Group President ..................................................................…...…… Date ……………….... |
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