Koori Curriculum Club Scholarship Application

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* 1. Full Name

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* 2. Email Address

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* 3. Phone Number (include area code)

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* 4. Employer/Service Company Name

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* 5. Company Address

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* 6. Does your service support vulnerable or disadvantaged communities?

Yes

No

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* 7. Explain how your service supports vulnerable or disadvantaged communities

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* 8. Are you Aboriginal or Torres Strait Islander?

Yes

No

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* 9. Is your service/employer an Aboriginal specific service?

Yes

No

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* 10. Why do you want to join the Koori Curriculum Club?

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* 11. What are your main goals?