Scholarships & Bursaries

Name Of Applicant

D.O.B

School

School Year

Instrument

No Of Years Study

Teacher

Name Of Teacher

Teacher may be asked to write a confidential report on the student

Is the applicant of Aboriginal descent?

Background other than English?

Does the applicant have a recognised disability?

List the school choir(s) the applicant will be a member of.

List the school ensemble(s) the applicant will be a member of.

Name

Address

Suburb

State

Post Code

Your Mobile

Your Email

No of dependant children

Family Structure

Do you receive Benefits?

Full Tax Return (not assessment) for latest Tax Year

Centrelink Payment Summary

Other information as requested by Bursary Committee

I/We understand that without proof of income the application is ineligible for consideration

I/We certify that the information is correct

I consent to NECOM collecting the data on this form