Yanburi Program Application Form PERSONAL DETAILS:STUDENT NUMBER (if known): YOUR NAME:* FIRST NAME: LAST NAME: GENDER:* MALE FEMALE DATE OF BIRTH:*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ADDRESS:EMAIL ADDRESS:* PHONE NUMBER:* COURSE INFORMATION:To be eligible for a Yanburi Scholarship you must be studying a higher education course at University in Western Australia. Also you must be a Wajarri Yamaji person and provide proof of academic enrolment and previous term success. Please indicate the program and which University you will be studying with for 2019: PROGRAM:* UNIVERSITY:* ARE YOU A CONTINUING STUDENT? Yes No HiddenCONTINUING STUDENTSCourse Results Drop files here or Select files Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB. Please upload course results for your previous term/semester. You can upload a PDF, JPEG or Microsoft Word document.FIRST YEAR STUDENTSARE YOU A RECENT SCHOOL LEAVER? Yes No HiddenIf yes, Please indicate name of school attended and the year of completion Are you entering your course via ATAR (please specify score), Bridging Course of TAFE qualification:Please upload certificate of transcript. You can upload a PDF, JPEG or Microsoft Word document. Drop files here or Select files Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB. Are you a Wajarri Yamaji person?* Yes No Unsure If you answered No to the above question you are not eligible for the Yanburi Scholarship. MOTHER: MATERNAL GRANDFATHER: MATERNAL GRANDMOTHER: FATHER: PATERNAL GRANDFATHER: PATERNAL GRANDMOTHER: For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au