2020 SCHOLARSHIPSStudent’s full name:

Address:

Phone number: Date of birth: / /

Sex: Male Female

Parents’ / guardians’ full names and occupations:

Name:

Occupation:

Name:

Occupation:

Primary school details:

Current primary school:Year 6 teacher’s name(s):Applying for:(Tick one or more)

Academic Scholarship Cultural Scholarship Sporting Scholarship

I agree to the conditions as set out in the scholarship offer, and will abide by the panel’s decision. I submit that the information in my application is true and accurate.

Applicant’s signature:

Parent’s signature:

Parent’s signature:

Primary school principal’s signature:

ACADEMIC SCHOLARSHIP – STUDENT

Student’s name:

Outline the academic results that you have achieved (e.g. Year 3, 5, 7 Test results or National Competitions etc.).

Describe your most outstanding academic success so far.

Outline your academic goals for the next 5 years.

Rate your abilities in the following “subject areas” out of 10 using this continuum (These will be compared to your teacher’s ratings).

Average Competent Highly Competent Outstanding

1 3 5 7 10

English: Reading _________

Writing _________

Speaking _________

Maths: _________

Social Studies: _________

LOTE: _________

Science: _________

Physical Education: _________

Music: _________

Art: _________

Applicants should also include a 200 word essay on your academic success, your ambitions and your goals as well as a copy of your most recent school report.

Completed submissions must be handed to your primary school principal by Friday, 20 th September 2019

ACADEMIC SCHOLARSHIP – TEACHERStudent’s name:

Please rate the applicant on each of the scales below:

Average Above average Outstanding ExceptionalNatural academic ability

Conscientiousness

Drive to succeed

Class contribution

Confidence / self-esteem

Cooperativeness

Classroom behaviour

Team contribution

Rate the applicant’s abilities in the following “subject areas” out of 10 using this continuum:

Average Competent Highly Competent Outstanding

1 3 5 7 10

English: Reading _________

Writing _________

Speaking _________

Maths: _________

Social Studies: _________

LOTE: _________

Science: _________

Physical Education: _________

Music: _________

Art: _________

Special skills / abilities exhibited:

Personal characteristics / attitude:

Any further comments:

Teacher’s name:

Teacher’s signature:

ACADEMIC SCHOLARSHIP – PRINCPAL

Student’s name:

Please provide a brief description of the qualities of this student, and your comments about their worthiness:

On a scale of 1 to 10 rate this student on his/her academic potential and briefly explain why.

Scale: ________

Special skills / abilities exhibited:

Personal characteristics / attitude:

Any further comments:

Principal’s name:

Principal’s signature:

After completing this page, please also complete Page 5 if there are multiple applicants from your school in this scholarship category. Please forward the completed application to Pioneer SHS.

ACADEMIC SCHOLARSHIP – COMPARISON

When there are multiple applicants from a primary school applying for the same category of scholarship, the primary school principal should complete this form and forward it to Pioneer SHS with the completed applications.

Primary school:

Rank order of applicants:

Exceptional 10

9

8

Outstanding 7

6

5

Above average 4

3

2

Average 1

Additional comments:

Principal’s name:

Principal’s signature:

Please forward completed applications in confidence to:

The Principal, Pioneer State High School, PO Box 8279, Mt Pleasant 4740

Marked “Scholarship Application”

Applications should be submitted to primary school principals by Friday, 20th September 2019,and should be forwarded to Pioneer SHS by Wednesday, 9th October 2019.