Scholarship Application Form — Blue Mountains Health Trust

Application Form

Name

First Name

Last Name

Email

Phone

(###)

###

####

Date of Birth

MM

DD

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 attach: Please provide a copy of latest exams and or assessment results along with most recent school reports.

Name of course you intend to study at university

Please attach: You will be required to provide a confirmation of the acceptance.

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 noted throughout the form and email through to info@bluemountainshealthtrust.com.au. The email should be titled with your full name.

Apply for a scholarship

Application Form

Blue Mountains Health Trust