1. National Academy Wildcard Scholarship Application Form
PERSONAL DETAILS
Name: _______________________ __________________________________
Family Name Given Names
Address: _____________________________________________________________
Street Number and Name
________________ ________________ ______________________
Suburb State Postcode
Telephone: ___________________ ____________________________
Home Mobile
____________________________ 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
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