National Academy Wildcard Scholarship Application Form PERSONAL DETAILS Name: _______________________ __________________________________ Family Name Given Names Address: _____________________________________________________________ Street Number and Name ________________ ________________ ______________________ Suburb State Postcode Telephone: ___________________ ____________________________ Home Mobile Email: ____________________________ Date of Birth: ____________________ What is your current AR? ________________ List your 3 best tournament results in the last 12 months: ______________________________________________________________________________________________ Please comment on why you would like to be considered for a Wildcard Scholarship (less than 50 words): ________________________________________________________________________________________________ Is your private coach aware that you are applying for a Wildcard Scholarship with Tennis Australia? (Y/N/NA) ___________ Applicant and Parent signature: Signed: _________________ _____________________ _______________ Applicant Parent Date Once signed, please send to National Academy Manager National Academy Manager signature: Signed: _________________ ________________ NA Manager Date Effective 1 January 2014 © Tennis Australia, 2014. All rights reserved