Scholarship Application Form

Your Contact Details

Your Name * Your name is required.

Your Email Address * Please leave a valid email so we can get in touch

Best Contact Number * Please leave a contact number so we can get in touch

Street Address

Suburb

Postcode

Parent/Guardian Details

Fill in the following details of the parent or guardian you feel we should talk to about the financial aspect of your going on a Rotary Youth Exchange.

Do you live with * This field is required

Parent/Guardian Name * Parent/guardian name is required.

Email Address * Please leave a valid email so we can get in touch

Best Contact Number * Please leave a contact number so we can get in touch

Relationship To You * This field is required

Parent/Guardian Additional Information

The following section is to be filled out by the person the student has listed above.

Do you or you and your spouse support the student financially? * This field is required

Do you own or are you buying your own home? * This field is required

What is yor annual income as shown in your last year's tax return? * This field is required

Is the student's family a single parent family? * This field is required

How many other children in addition to the student are in the family? * This field is required

What are the ages of the other children in the family?

Can you come to Adelaide for an interview? * This field is required

Additional Comments/Questions

Scholarship Scheme

Scholarship Application Form

Your Contact Details

Parent/Guardian Details

Parent/Guardian Additional Information

Exchange Program