EmailMeForm
Netball WA Scholarship Application
Scholarship Type
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Coach - Bette Allison Scholarship
Umpire - Fay Bevan Scholarship
Manager - Flo Starcevich Scholrshipa
Name
*
First
Last
Email
*
Registered with your club/association in PlayHQ for 2025?
*
Please select
Yes
No
Unsure
How many years have you been active at your club/association?
*
How would you use the scholarship money?
*
Accreditation
Education/Upskill
Travel expenses
Other
If other, please specify:
Photo Upload
Netball headshot/action shot
Declarations by Applicant
Privacy Statement and Statement of Disclosure
*
Place name in box above to show you have read the below:
Privacy Statement and Statement of Disclosure
The Organisation acknowledges and agrees that this Agreement and information regarding it is
subject to the Freedom of Information Act 1992 and that the Grantor may publicly disclose
information in relation to this Agreement, including its terms and details of the Organisation.
You can access any information provided by you to Netball WA during standard office hours
and updated in writing to Netball WA. All information provided on this form and gathered
throughout the assessment process will be stored on a database that will only be accessed
by authorised departmental personnel and is subject to privacy restrictions.
Netball WA may wish to provide certain information to the media for promotional purposes. The
information will only include the applicants Club and Association location and scholarship purpose.
I have read and understood the 2025 Scholarship Guidelines.
*
Please select
Agree
Do Not Agree
Guidelines sent via email
I hereby certify that to the best of my knowledge, the information given above, and any other supporting documentation is correct.
*
Please select
Agree
Do Not Agree
Referee Details
Please supply at least 1 referee
Referee 1 Name
*
First
Last
Email
*
Phone
*
Netball Role
*
Name of club/association
*
Referee 2 Name
First
Last
Email
Phone
Netball Role
Name of club/association