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Supplementary Application Form – All Rounder Scholarship Personal Details
Name (as on birth certificate):_____________________________________________________________________ Citizenship: ____________________________ Home country residential address: ______________________________________________________________________________________________________________________________________________________________ Home country telephone #: ________________________ Suva residential address: ______________________________________________________________________________________________________________________________________________________________________ Suva telephone #: _________________________ Next of kin: ____________________________________________________________________________________ Next of kin’s Residential Address: ________________________________________________________________________________________________________________________________________________________________ Next of kin’s home telephone/mobile #: ________________ Office telephone #: _____________________________ Personal Ailments/illnesses/ conditions: (e.g. diabetic) ___________________________________________________ Allergies: (e.g. penicillin) __________________________________________________________________________ Which Sports Scholarship are you applying for? (please tick one only) Athletics  Basketball  Netball  Rugby  Soccer  Swimming  Volleyball  Weightlifting Passport Details
Number: _________________________________ Expiry date: ________________________________ Which National Olympic Committee or Sporting Federation is nominating you? _____________________________________________________________________________________________________________________ Number of years/months experience competing in the above chosen sport What is the highest level of competition you have participated in? Supplementary Application Form – All Rounder Scholarship Have you traveled outside your country to take part in competitions? (If yes, please name countries and competition) Competition
_______________________________________________________ _______________________________________________________ _______________________________________________________ Have you received any training related to your sport overseas? (If yes, please attach proof of training schedule) Do you have a personal trainer or team coach? (if yes, please provide name and address) ____________________________________________________________ Address: ____________________________________________________________ ___________________________________________________________________________ How many hours of training do you currently do? Do you have a personal/individual/team sponsor for your sport? (If yes, please name sponsor and contract period.) Sponsor: ______________________________________ Contract period: __________________________ List any award or scholarship you have received: _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________

Source: http://koro.student.usp.ac.fj/pipermail/emalus-campus-students/attachments/20061016/25ca508c/SupplementaryApplicationForm.pdf

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Lufkin ISD 11/01/10 Monthly Check Register Check # Payee Key Payee Name T Check Date Check Amount Date DISB FIRST BANK & TRUST EAST TEXAS 186942 A-1 SELF000 A-1 SELF STORAGE & PACK M R 10/05/2010 $50.41 10/05/2010 186943 ABNEY & 000 ABNEY & SONS HARDWARE, IN R 10/05/2010 $824.59 10/05/2010 186944 ALCOHOL 000 ALCOHOL DRUG ABUSE COUNCI

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