Football SA & Variety SA Scholarship Grant Application Form
Complete the below information to apply for the scholarship grant. Please note: all applications are not guaranteed to be a recipient of the grant. Note: You can Save your application and complete at any time.
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Type of Grant
Grant Applying For
*
Please Select
Education & Pathway Scholarship
Participation Support Grants
Micro & Inclusion Grant
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Child Details
Name:
*
First Name
Last Name
Gender
*
Please Select
Female
Male
Other
Prefer not to say
Date of Birth (DD/MM/YYY)
*
Club Name
*
FFA Number
*
Is the child an Australian Resident/Citizen?
*
Yes
No
Is the child of Aboriginal or Torres Strait Islander Origin?
*
Yes - both
Yes - Aboriginal Origin
Yes - Torres Strait Islander Origin
No
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Disability/Disadvantage
Please provide a short description of the child's disability or disadvantage.
*
Is the child receiving NDIS Funding?
*
Yes
No
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Parent, Guardian or Carer Information
This person MUST be over 18 years old.
Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Sibling
Aunt
Uncle
Cousin
Grandparent
Guardian
Carer
Home Address
*
Street Address
Street Address Line 2
Suburb
State
Postcode
Contact Number
*
Please enter a valid phone number.
Format: +61 000 000 000.
Email
*
example@example.com
Is the parent, guardian or carer currently employed?
*
Please Select
Yes - Full Time
Yes - Part Time
Yes - Casual
No
Current Housing Consideration
*
Own Home Outright
Renting
Mortgage
Government Assistance Housing
Other
Current Gross Income Per Annum of Household
Only required if applying for a Tier 1 or 2 Scholarship.
Proof of Income
Only Complete if you are applying for a Tier 1 or 2 Scholarship.
Does the Parent, Guardian or Carer receive Government Assistance Payment?
Yes
No
Please upload your current Healthcare Card
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Please upload Proof of Income Document(s) of the Parent, Guardian or Carer. Examples may include: Centrelink Statement, Recent Pay Slips, Healthcare Card, Supporting Agency Letter, Bank Statements.
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These documents must be current, and provided within the last three months.
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Scholarship Funding
Please upload receipt(s) of payment or a quote(s) for the goods/services you would like covered by the grant
*
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Referees
Referee 1 must be from the following: Health care professional, teacher, social worker or specialist. Referee 2 must be a club representative from the child's current club.
Allied Health/Teacher Referee
Name
*
First Name
Last Name
Organisation
*
Position
*
Phone Number
*
Please enter a valid phone number.
Format: (00) 0000-0000.
Email
*
example@example.com
Relationship to Child
*
E.g. GP, Psychologist, Teacher
Please upload your referral letter which briefly outlines why this scholarship will benefit this child.
*
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Club Referee
Name
*
First Name
Last Name
Organisation/Club
*
Position
*
Contact Number
*
Please enter a valid phone number.
Format: +61 000 000 000.
Email
*
example@example.com
Relationship to Child
*
E.g. Club Secretary, Club President
Please upload your referral letter which briefly outlines why this scholarship will benefit this child.
*
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Consent
If the child is a successful applicant of the scholarship program, do you consent to Football SA and/or Variety SA using their name for promotion?
*
Yes
No
Name
*
First Name
Last Name
Signature
*
Today's Date (DD/MM/YYYY)
*
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