EDUCATIONAL SCHOLARSHIP FUND

Nomination Form

If not the applicant, name of person completing this form -
Relationship to the Applicant -
APPLICANT DETAILS
First name
Surname
Postal Address
Residential Address
Telephone number
Email address
Information to assist with determining eligibility / for scholarship categories:
Is the applicant an Australian citizen or permanent resident of Australia?
(If your answer is no your are not eligible to receive a scholarship) / Yes
No
Is the applicant of Aboriginal or Torres Strait Islander heritage? / Yes
No
Gender of the applicant?
Age of the applicant?
Is the applicant under the guardianship of the Minister or exited the guardianship of the Minister? / Yes
No
SCHOLARSHIP DETAILS
Scholarship applicant is applying for -(please circle, for more information on each scholarship please refer to the Educational Scholarship Guidelines. You can select more than one scholarship, if you are applying for different scholarships only one nomination form is required. The Stand Like Stone Board may match your nomination to the appropriate scholarship.) / L M Woodruff Memorial Scholarship
Vititec Penola Coonawarra Community Scholarship
Mount Gambier High School Student Scholarship
Keith Area School Student Scholarship
Kingston Community School Student Scholarship
Grant High School Student Scholarship
Lucindale Area School Student Scholarship
L T O’Connor Scholarship
de Nys Family Memorial Scholarship
Focis on Youth
Stand Like Stone Scholarship
Cornerstone Scholarship
SARWG Scholarship
The Balnaves Foundation Scholarship
The LE & NC Myers Scholarship
Lorry Humphreys Memorial Scholarship
EDUCATION
Level obtained / Name of school / institution / Year started and completed / Qualification
Course scholarship will be applied to -
(This must be an approved curriculum and course at an Australian educational institution that are recognised by Australian educational authorities. The approved Australian course can be pre-school, primary school, secondary school or tertiary / vocational courses.)
Reasons for undertaking this course -
Outline challenges that may be faced in undertaking the nominated course -
Outline examples that demonstrate how the applicant has managed and/or overcome personal difficulties -
Outline the applicant’s current community involvement -
Outline how applicant will contribute to the Limestone Coast in the future -
Explain how a Stand Like Stone Foundation Scholarship would benefit applicant and the difference a scholarship will make to applicant personally and / or applicant’s family.
Is there any additional information you would like us to consider such as personal and / or family disadvantage, financial hardship, academic or other achievements, particular talents or special interests. (Relevent supporting documents are welcome to be attached to the application.)
REFEREES
The contact details of two referees who have direct knowledge of applicant’s educational ability, prospects and character are required. Please provide this in the space below.
A signed letter of recommendation is required from each referee, please attach to nomination form.
Referee 1
Name / Title:
Phone / Email:
Referee 2
Name / Title:
Phone / Email:

I declare that all the information provided in this application is true and correct.

I understand that if the Stand Like Stone Foundation approves a scholarship, the applicant (or parent/guardian) is required to accept the conditions of the scholarship as outlined in the Stand Like Stone Foundation Educational Scholarship Conditions.

The applicant gives permission to the Stand Like Stone Foundation to contact any persons or organisation in the assessment of the application and understand that information may be provided to other organisations, as appropriate.

Applicant’s signature / Date

EDUCATIONAL SCHOLARSHIP APPLICATION

CHECKLIST

HAVE YOU DONE THE FOLLOWING? / YES
APPLICATION has been signed by the Applicant or the person completing the form on behalf of the applicant
PROVIDED signed letter of recommendation & contact details for TWO referees
ENSURED the application is NOT stapled, is NOT in a folder, is NOT bound and is NOT printed double sided
If you have previously received a scholarship from Stand Like Stone, have you completed and returned the Scholarship Student Acquittal Report to Stand Like Stone?
Ensured the application is lodged by mail/email and is postmarked/received
no later than 5.00pm on the closing date.
NO LATE APPLICATIONS WILL BE ACCEPTED

Stand Like Stone Foundation

Educational Scholarship Application Form 1