Apply for a Scholarship

To: PEiPL Ltd *

My details appear below and I would like to be considered for a Eurekamp Oz! Scholarship. I understand that I must obtain the consent of my parent(s) or legal guardian to attend Eurekamp Oz! if I am offered a partial or full scholarship.
I am the parent/legal guardian of the child whose details appear below and would like my child to be considered for a Eurekamp Oz! Scholarship

Child's Name *

First

Last

Date of Birth *

Usual ResidentialAddress *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

School *

Are you a member of the Children's University?

Name *

First

Last

Phone Number *

Email *

Consent to child attending Eurekamp Oz! *

Preferred Camp (name of camp, location and week): *

Signature *

Type your name to sign the form

Date *

Eligibility for a EurekampOz Scholarship *

Tell us why you believe that the child nominated above is eligible for a partial or full scholarship (<100 words)