The “Ruby Tout” Academic Scholarship Application Form

Available to students entering

Year 7, 9 & 11 in 2018

Applicant Details

Surname: ______

Given Names:______

Address:______

______

Phone Number:______Date of Birth:______

Language/s spoken at home:______

Current school:______

Current Year Level:______

Subjects currently being studied:______

______

______

Years of previous scholarship if any:

Parent/Guardian Details

Father/Guardian Title:______Mother/ Guardian Title:______

Surname:______Surname:______

Given Name:______Given Name:______

Address:______Address:______

Postcode:______Postcode:______

Phone (home):______Phone(home):______

Phone (business):______Phone(business):______

Mobile: ____Mobile:______

Email:______Email:______

Signature of Parent/Guardian:Date:______

Applicant Statement

Name of Applicant:___

Please answer the following questions:

1. What makes you a suitable applicant for the “Ruby Tout” Academic Scholarship?

2. In what way is receiving this Scholarship important to you?

3. What goals might you achieve through the Presentation College Windsor Scholarship program?

4. Give an example of something you have achieved and of which you are proud?

Applicant Declaration

I declare that, to the best of my knowledge the information supplied in this application and the supporting documentation are true and complete. I acknowledge that the provision of false information or documentation or the withholding of information or documentation relating to my application may result in the cancellation of any scholarship by Presentation College Windsor. I confirm that I have read and understood the information for applicants and understand the conditions of the scholarship. I authorise PCW to obtain, where necessary, further information regarding this application from other relevant bodies, I understand that the scholarship process is competitive and that not all applicants who meet the eligibility criteria can be awarded a scholarship.

Signature:______

Date:______

Applications for all scholarships, prizes and awards will close on

Friday June 16, 2017

Applications must include the following:

  • School Reports from the past 2 years, including attendance records
  • Family Statement Form
  • Academic Reference Form (a supporting statement from a current teacher who can confirm the applicant’s high academic potential)
  • Community Reference Form (supporting statement from a member of the local community confirming that applicant’s participation in and contribution to their local community)

Mail: The Principal’s PA,Mrs Trish Chester

Presentation college Windsor

187 Dandenong Rd, Windsor Vic 3181

Or Email:

PCW “Ruby Tout” Academic Scholarship

Academic Reference

The purpose of the Academic Reference which is to be provided by a teacher is to confirm that the applicant has the academic potential and motivation to succeed at PCW.

Name of Applicant:______

Name of Academic Referee:______

Name of School:______

How long have you known the applicant:______

Reference (maximum of 300 words)

PCW Melbourne “Ruby Tout” Academic Scholarship

Community Reference

The purpose of the Community Reference is to establish the involvement in, and commitment of the applicant, to her community. This form can be completed by any community leader nominated by the applicant. The reference should include involvement in any sporting, school, social and/or community activities. Please include any information you believe may be relevant or useful.

Name of Applicant:______

Name of CommunityReferee:______

Community Role (Sports Coach/Religious Leader):______

How long have you known the applicant:______

Reference (maximum of 300 words)

PCW Melbourne “Ruby Tout” Academic Scholarship

Family Statement

The purpose of the family statement is to establish the support structure of the applicant. Please include any information you believe may be relevant or useful.

Name of Applicant:___

Name of Family Member completing statement:______

Relationship to Applicant:______

Please answer the following questions:

1. What do you believe makes your daughter a suitable applicant for the PCW “Ruby Tout” Academic Scholarship?

2. In what way is receiving this Scholarship important to your family?

3. What goals do you hope your daughter may achieve through the PCW Scholarship program?

4. Describe your family, for example how many children there are, who lives in the family home and any other important details.

5. If applicable, please attach Centrelink or Australian Tax Office documentation to this application form which confirms your status as a low income family.

Application Form Creating Bright Futures