HOLROYD CITY COUNCIL

SCHOLARSHIP APPLICATION 2013
APPLICATIONS CLOSE - MONDAY 25 JANUARY 2013
All Applicants must:

supply a certified copy of their birth certificate if born in Australia, or proof of citizenship status
if born overseas.

provide a Statutory Declaration verifying their current residential address.

ensure that any required supporting documentation is attached, otherwise their application will
not be considered.

complete Section 12

1

Date Received

PERSONAL DETAILS
Family Name: ...................................................................Given Names: ..................................................................
Address: .....................................................................................................................................................................
….. ......................................................................................State: ................................Postcode:................................
Phone: (H)...........................................................................(Mob) ...............................................................................
Date of Birth: …………………………………………… Age: (as at 31 March 2013) ……………………………
Resident of Holroyd since: ……………………………………………………………………………………………

2

SCHOOL DETAILS
Name of School: ..........................................................................................................................................................
Address of School: .......................................................................................................................................................
............................................................................................State: ................................Postcode:................................
Phone Number of School:.............................................................................................................................................
HSC Candidate Number: ....................................................Year HSC completed: .....................................................

FILE: HC-03-05-15/04

................................................................... ............................................ ..................................................................................................................................................................................................................................... FILE: HC-03-05-15/04 ..................................................Please indicate the subjects you studied in Year 12 and indicate the level eg. .................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... ................................................................ years 6 Has your enrolment been confirmed? ………………………………………………………………………………… (please attach copy of confirmation) 7 Educational disadvantage: please provide details of any recent circumstances which disrupted or adversely affected your education and/or ATAR outcomes............................................................................................................................................................................................................. 9 What community benefit.......................... if any.................... Mathematics Extension 1 SUBJECT LEVEL SUBJECT LEVEL 3 ATAR score:...................................... ....................................................... ................ ............................................................ 8 How would this scholarship benefit your career aspirations? ................................................................................................................................................................................................................................................................. ........................................................................................................... ......................................................................................... 4 Proposed UWS course of study in 2013: ................................................................................................................................................................................................................................................................ 5 Length of proposed course: ................ ....................................................... ............................... 10 Give details (name and value) of any other grants or scholarships you have been offered in relation to your university studies............................................................................................. do you think will result if you are awarded the scholarship? .............. ................................................................................................................................................. .....................................................................................................................

.11 Applicants should note that this scholarship can be revoked at any time..g.. 12 DECLARATION BY APPLICANT I hereby declare that the information submitted in this application is accurate........ Holroyd City Council 16 Memorial Avenue Merrylands Applicants are welcome to include copies of other documents which may assist Council in considering their application e................ Should Council form the opinion that a student’s conduct is not fitting for a scholarship holder.... disseminated.................................. All information will be collected............ I further declare that in accordance with the conditions of eligibility in the information sheet. or your application will not be considered.. Applicant’s Signature: .. or destroyed in accordance with relevant privacy and records management laws and the Council’s policies and practices. FILE: HC-03-05-15/04 . Date: . Council may in absolute discretion revoke such scholarship without affording any reason. Information collected via this form will only be used by the Council for the purposes for which it is being collected.. references. and accept the condition in Clause 11........... then mail your application to: Library & Community Services Dept. stored.. I acknowledge that the decision reached by Holroyd City Council for the award of the Scholarship is final....... 13 LODGING YOUR APPLICATION Please attach original or certified copies of all required documentation. I meet the requirements deemed essential for the 2013 Council Scholarship..... awards......... certificates. academic record..... accessed.... Holroyd City Council PO Box 42 MERRYLANDS NSW 2160 or hand deliver to: Library & Community Services Dept........................

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