National Academy Full 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: ____________________ CRITERIA DETAILS – FULL SCHOLARSHIP Please give specific details of the criteria that you meet for Full Scholarship National Ranking __________________________________________________________________ Result Participation _________________________________________________________________________ International Ranking __________________________________________________________________ Result Participation Signed: _________________ ________________ ______________ _______________ Applicant Parent NA Manager Date Send to: National Academy Manager Scholarship Criteria effective 1 January 2014 © Tennis Australia, 2014. All rights reserved