Apply for a scholarship

Application Form

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your school

Subject Studied

Please list subjects studied at school

Assessment & Exam Results

Please provide a copy of latest exams and or assessment results along with most recent school reports. This can be uploaded on the final question on this form.

Name of course you intend to study at university

You will be required to provide a confirmation of the acceptance. This can be uploaded on the final question on this form.

Extra activities and organisations

Please outline any organisations, sport, community service or activities you participate in both within and outside of school. Please attach: Please provide supporting documents to verify your participation.

A little bit about you

Name of Parent or Guardian

First Name

Last Name

Email of Parent or Guardian

Phone of Parent or Guardian

(###)

###

####

Please ensure you collate supporting documentation and upload files on the the bottom of the the form.

Apply for a scholarship

Application Form

Blue Mountains Health Trust