Yanburi Scholarship Payment Form

NAME:*
FIRST NAME: LAST NAME:
ADDRESS:*
STREET: SUBURB: POSTCODE:
PHONE:*
STUDENT SIGNATURE

I agree that my typed name above can be used as a digital representation of my signature to that fact.
BANK DETAILS
BSB:*
ACCOUNT:*
PAYMENT DETAILS:
NAME:*
FIRST NAME: LAST NAME:
NUMBER OF COURSES ENROLLED IN:*

You will receive $125 per course
ENROLMENT:*
Please upload enrolment details. You can upload a PDF, JPEG or Microsoft Word document.
Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
NUMBER OF SUBJECTS ENROLLED IN:

You will receive $250 per Subject
COURSE PAYMENT:*
Please upload transcripts. You can upload a PDF, JPEG or Microsoft Word document.
Drop files here or

Accepted file types: pdf, jpg, doc, docx, Max. file size: 10 MB.
NUMBER OF SUBJECTS ENROLLED IN:

You will receive $250 per subject
LIST SUBJECTS:*
TOTAL REIMBURSEMENTS
For any application enquiries please contact the office on 08 9997 3444 or email members@wajarri.com.au

BANK DETAILS