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:

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

CULTURAL SCHOLARSHIP – STUDENT

Student’s name:

Area(s) of cultural excellence (Tick one or more):

INSTRUMENTAL MUSIC Instrument/s: ________________________________________________ CHORAL MUSIC / SINGING DANCE SPEECH AND DRAMA ART Which Visual Arts: _________________________ (e.g. painting, pottery)

Describe the level of excellence / participation reached (e.g. Grade 4, Speech or Eisteddfod Section prize):

What are your cultural ambitions for the next 5 years?

Describe what training / practice you currently do:

Describe your most outstanding cultural success so far:

Forward your application to your primary school principal. Your primary school principal will complete Page 3 of the application and forward the completed application to Pioneer State High School.

Applicants should also include a 200 word essay on their area of cultural excellence, their abilities and their goals.

CULTURAL SCHOLARSHIP – PRINCIPAL

Student’s name:

Please rate the applicant on each of the scales below:

Average Above average Outstanding ExceptionalCultural participation

Natural talent

Practice persistence

Co-operation (teamwork)

Cultural success level

Drive to succeed

Cultural goals/aspirations

Academic ability

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

Scale: ________

Special cultural skills or abilities exhibited:

Personal characteristics / attitude:

Any further comments, including feedback from instrumental music teachers or other relevant staff:

Principal’s name:

Principal’s signature:

After completing this page, please also complete Page 4 if there are multiple applicants from your school in this scholarship category. Please forward the completed application to Pioneer SHS.

CULTURAL 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, 9 th October 2019 .