2017 SPIRIT OF ADVENTURE SCHOLARSHIP
APPLICATION FORM
This Scholarship is only available to Chilton Saint James School
2017 Year 12 students.
Surname
Christian Name
Date of Birth
Home Contact Details / Address:
Home Phone:
School/s with Years of Attendance
Reason for Scholarship Application
(to be completed by the student) Write a statement of why you wish to be considered for this Scholarship and what you think you and your school would gain from it.
If more space is required, please attach statement to this application.
Two Written References
Please provide and attach two written references from referees, outside of Chilton.
Recreational Interests
Give details of sports, cultural activities, positions of responsibility etc both within and outside school, social or service to the community.
Achievements
Give details of examinations passed, representative honoursetc
Spirit and Passion
Give examples of how you show or have shown School spirit and passion for Chilton Saint James.
Parent Contact
Contact 1 Name
Contact 1 Details / Address:
Home Phone: Mobile Phone:
Email:
Contact 2 Name
Contact 2 Details / Address:
Home Phone: Mobile Phone:
Email:
Medical Criteria,
Code of Conduct and Terms and Conditions / The applicant and their parent confirms they have a full understanding of the 10 Day Development Voyage Medical Criteria.
The applicant and their parent have read, understood and accept the code of conduct and terms and conditions for the Spirit of Adventure at the link below:
Signature of Applicant
Signature of Parent
Scholarship Applications close on Friday 29 September 2017 at 3.00pm.
The Scholarship will be awarded solely after an interview and at the discretion of the Selection Committee.
No correspondence will be entered into.
No late entries will be accepted.
The Selection Committee will comprise ofmembers of the Chilton Old Girls’ Association and staff members.
Scholarship applications and documentation can be submitted by:
Post/ or delivery to Reception
Chilton Old Girls’ Association
Chilton Saint James School
124 Waterloo Road
PO Box 30090
Lower Hutt 5010