Scholarship ApplicationScholarship SubmissionApplicant DetailsTo help us better direct your application please tick the following if your child has a hearing loss*Yes, my child has a hearing loss.No, my child does not have a hearing loss.Is your child currently attending any of TSH's group programs?*Please select all that may apply. No Yes, Chatterbox Yes, Talkabout Yes, OutpostNDISBursaries and Scholarships are designed to support those families in financial difficulties who do not have access to any alternate therapy funding sources eg NDIS.Does your child currently receive NDIS funded services or is an application for NDIS funding in process?*YesNoYour ChildChild's Name* First Last Child's Date of Birth* Date Format: DD slash MM slash YYYY Child's Parent(s)/Caregiver(s)/ Name* First Last Address* Street Address City ZIP / Postal Code Home PhoneMobile Phone*Email* Other Dependent ChildrenFull NameYearFees (Per Year) Income DeclarationFather's Occupation*Mother's Occupation*Father's Income (Net Per Fortnight)*Please enter a number greater than or equal to 0.Mother's Income (Net Per Fortnight)*Please enter a number greater than or equal to 0.Family Benefit (Net Per Fortnight)*Please enter a number greater than or equal to 0.Other Income (Dividends, Interest ect Net Per Fortnight)*Please enter a number greater than or equal to 0.Total Income Fortnight*Other DetailsIn addition to this application for fee relief in an Outpost school you may be asked to provide:A letter from the school advising that you are unable to access a school bursary from your Outpost school.A copy of the invoice from the school stating the school fee amount.Reason for scholarship applicationReason for Fee Relief Application*Please select all that apply Lack of employment Health Difficulties Other CircumstancesFee Relief Duration*Please select all that apply or tick all if required for a year. Select All Term 1 Term 2 Term 3 Term 4Amount of Fee Relief Requested*Please select the option that best suits your need. 25% Relief 50% Relief 75% Relief 100% ReliefStatement of financial need:*Please explain the factors contributing to this application of financial support.ScholarshipsWhich scholarships would you like to apply for?*Select all that may apply. Hearing Research Foundation Bursary McCusker Foundation Scholarship Perth Airport Scholarship Rotary International Scholarship Stan Perron Scholarship Tomasi Family ScholarshipDeclarationI/We,Understand that we are required to notify TSH immediately should we be approved for NDIS funding.Understand that full fees are payable unless the scholarship is awarded;Understand that Scholarships are allocated for one year and will be reviewed each term;Understand that we will notify TSH if our circumstances change and we are able to pay our fees;Acknowledge that all information contained in this application is true and correct;Understand our information could be shared with a third party as part of the assessment, approval and audit process;Understand each scholarship will have it’s own terms and conditions;Understand media consent may be a condition of the scholarship provider. This media consent is solely for the purposes of providing feedback and transparency for the donors not an unlimited consent to advertise in the broader community.I acknowledge I will be required to submit payslips, Australian Taxation Office Notice of Assessment, and Centrelink Income statement in order for this application to be assessed.Copy of DeclarationI/We, Understand that we are required to notify TSH immediately should we be approved for NDIS funding. Understand that full fees are payable unless the fee relief is approved; Understand that Scholarships are allocated for one year and will be reviewed each term; Understand that we will notify TSH if our circumstances change and we are able to pay our fees; Acknowledge that all information contained in this application is true and correct; Understand our information could be shared with a third party as part of the assessment, approval and audit process. Understand each scholarship will have it's own terms and conditions; Understand media consent may be a condition of the scholarship provider. This media consent is solely for the purposes of providing feedback and transparency for the donors not an unlimited consent to advertise in the broader community; I acknowledge I will be required to submit payslips, Australian Taxation Office Notice of Assessment, and Centrelink Income statement in order for this application to be assessed.Declarer's Name* First Last Parent(s)/Caregiver(s) Agreement* I AGREE to the Declaration above and that the information that I have provided is accurate.PhoneThis field is for validation purposes and should be left unchanged.
