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District 9520 Youth Exchange Scholarship Application Form
 
The CLOSING DATE for Applications for Financial Assistance Scholarships for 2011 is 12 March 2010

PLEASE NOTE: Items marked with * are compulsory and must be completed

Click here to view the Privacy Statement Directed to Scholarship Applicants and their Families or Guardians.

Before you begin make your Scholarship Application, please note that you have 30 minutes in which to complete and submit your Application Form after which the page will 'time out'. It is advised that you print off the blank form and prepare your answers before returning to the page to complete and SUBMIT the form.
 

The following section is to be filled out by the student applying to go on exchange
 
Your full name*
Your email address*
Phone*
Your address*
  Post Code*
Do you live with*
 
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.
Name*
Work Phone:
Home Phone*
Relationship to you*
Email:
Fax:
 

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?*
Do you own or are you buying your own home?*
What is yor annual income as shown in your last year's tax return?* $
Is the student's family a single parent family?*
How many other children in addition to the student are in the family?*
What are the children's ages?
Can you come to Adelaide for an interview?*
     
Rotary District 9520

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