Scholarship Application

This page is being updated

You may see the submission forms changing in the near future.

Please note before filling IN the form:

TAB ONE: Talkabout/Literacy Program: For children with a speech or language delay aged 2-8 years old.

TAB TWO: Chatterbox Program: For children with a permanent hearing loss aged 0-5 years old.

TAB THREE: Outpost Program: For primary and high school students with a permanent hearing loss.

Talkabout

Chatterbox

Outpost

Talkabout

Scholarship Submission – Talkabout

Applicant Details
To 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, Talkabout 2
- Yes, Talkabout 3
- Yes, Talkabout 4
- Yes, Talkabout 5
- Yes, Talkabout Literacy
If no, please indicate the enrolled program* (applicants need to complete this section).
NDIS
Bursaries 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?*
- Yes
- No
Your Child
Child's Name*
First Last
Child's Date of Birth*
DD slash MM slash YYYY
Child's Parent(s)/Caregiver(s)/ Name*
First Last
Address*
Street Address City ZIP / Postal Code
Home Phone
Mobile Phone*
Email*
Other Dependent Children
Full Name Year Fees (Per Year)
Income Declaration
First Parent/Guardian's Occupation*
Second Parent/Guardian's Occupation*
First Parent/Guardian's Income (Net Per Fortnight)*
Please enter a number greater than or equal to 0.
Second Parent/Guardian'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 Details
Reason for scholarship application
Reason for Fee Relief Application*
Please select all that apply
- Lack of employment
- Health Difficulties
- Other Circumstances
Fee Relief Duration*
Please select all that apply or tick all if required for a year.
- Select All
- Term 1
- Term 2
- Term 3
- Term 4
Hidden
Amount of Fee Relief Requested
Please select the option that best suits your need.
- 25% Relief
- 50% Relief
- 75% Relief
- 100% Relief
On a fortnightly basis, how much can you contribute toward fees?*
Statement of financial need:*
Please explain the factors contributing to this application of financial support.
We will evaluate your suitability for each scholarship based on your submission.
Declaration
I/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 its own terms and conditions;
- Understand there might be media obligations, including a meet-and-greet with scholarship providers. This media consent is solely for the purposes of providing feedback and does not serve as an unlimited consent to advertise to the broader community;
- 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.
Hidden
Copy of Declaration
I/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.
Email
This field is for validation purposes and should be left unchanged.

Chatterbox

Chatterbox Bridge Funding

Applicant Details for
Chatterbox Bridge Funding
Is your child currently attending any of TSH's group programs?*
Please select all that may apply.
- No
- Yes, Chatterbox
NDIS
Bursaries and Scholarships are designed to support those families in financial difficulties who do not have access to any alternate therapy funding sources eg NDIS.
Are you in the process of securing NDIS funding?*
- Yes
- No
Your Child
Child's Name*
First Last
Child's Date of Birth*
DD slash MM slash YYYY
Child's Parent(s)/Caregiver(s)/ Name*
First Last
Address*
Street Address City ZIP / Postal Code
Home Phone
Mobile Phone*
Email*
Other Dependent Children
Full Name Year Fees (Per Year)
Hidden
Untitled
The current scholarships on offer are as follows: Hearing Research Foundation Bursary McCusker Foundation Scholarship Perth Airport Scholarship Rotary International Scholarship Stan Perron Scholarship We will evaluate your suitability for each scholarship based on your submission.
Declaration
I/We,
- Understand that we are required to notify TSH immediately should we be approved for NDIS funding.
- Understand that Scholarships are allocated for one year and will be reviewed each term;
- Understand that we will notify TSH if our circumstances change
- 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 its own terms and conditions;
- Understand there might be media obligations, including a meet and greet, with scholarship providers. This media consent is solely for the purposes of providing feedback and transparency for the donors and does not serve as an unlimited consent to advertise to the broader community;
- 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.
Hidden
Copy of Declaration
I/We, Understand that we are required to notify TSH immediately should we be approved for NDIS funding. Understand that Scholarships are allocated for one year and will be reviewed each term; Understand that we will notify TSH if our circumstances change; 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;
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.
Email
This field is for validation purposes and should be left unchanged.

Outpost

Scholarship Submission – Outpost

Applicant Details
Is your child currently attending TSH's Outpost program?*
Please select all that may apply.
- Yes
- No
Please indicate which school they will be attending.
Your Child
Child's Name*
First Last
Child's Date of Birth*
DD slash MM slash YYYY
Child's Parent(s)/Caregiver(s)/ Name*
First Last
Address*
Street Address City ZIP / Postal Code
Home Phone
Mobile Phone*
Email*
Other Dependent Children
Full Name Year Fees (Per Year)
Income Declaration
First Parent/Guardian's Occupation*
Second Parent/Guardian's Occupation*
First Parent/Guardian's Income (Net Per Fortnight)*
Please enter a number greater than or equal to 0.
Second Parent/Guardian'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 etc Net Per Fortnight)*
Please enter a number greater than or equal to 0.
Total Income Fortnight*
Other Details
In addition to this application for fee relief in an Outpost school you may be asked to provide:
1. A letter from the school advising that you are unable to access a school bursary from your Outpost school.
2. A copy of the invoice from the school stating the school fee amount.
Reason for scholarship application
Reason for Fee Relief Application*
Please select all that apply
- Lack of employment
- Health Difficulties
- Other Circumstances
Fee Relief Duration*
Please select all that apply or tick all if required for a year.
- Select All
- Term 1
- Term 2
- Term 3
- Term 4
Hidden
Amount of Fee Relief Requested
Please select the option that best suits your need.
- 25% Relief
- 50% Relief
- 75% Relief
- 100% Relief
On a fortnightly basis, how much can you contribute toward fees?*
Statement of financial need:*
Please explain the factors contributing to this application of financial support.
We will evaluate your suitability for each scholarship based on your submission.
Hidden
Scholarships on offer
The current scholarships on offer are as follows: Hearing Research Foundation Bursary McCusker Foundation Scholarship Perth Airport Scholarship Rotary International Scholarship Stan Perron Scholarship We will evaluate your suitability for each scholarship based on your submission.
Declaration
I/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 its own terms and conditions;
- Understand there might be media obligations, including a meet and greet, with scholarship providers. This media consent is solely for the purposes of providing feedback and transparency for the donors and does not serve as an unlimited consent to advertise to the broader community;
- 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.
Hidden
Copy of Declaration
I/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.
Email
This field is for validation purposes and should be left unchanged.

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Telethon Speech & Hearing is committed to upholding the rights and safety of all children and young people. This includes being a child safe organisation where children, young people, families, and community members can feel that their culture, abilities and identities are respected. Telethon Speech & Hearing acknowledges the Traditional Aboriginal and Torres Strait Islander Custodians of the land on which we work, live and build stronger communities for children and families to thrive. We recognise their continued custodianship and connection to land, waters and community and pay our respects to Elders past, present and emerging. We extend this respect to all First Nations people present today and welcome all Aboriginal and non-Aboriginal families to our centre and school.

Full Name	Year	Fees (Per Year)

Full Name	Year	Fees (Per Year)

Full Name	Year	Fees (Per Year)

Scholarship Application

Scholarship Submission – Talkabout

Applicant Details

NDIS

Your Child

Income Declaration

Reason for scholarship application

Declaration

Chatterbox Bridge Funding

Applicant Details for

NDIS

Your Child

Declaration

Scholarship Submission – Outpost

Applicant Details

Your Child

Income Declaration

Reason for scholarship application

Declaration

Donate and make a difference