APPLICATION forms must be received & COMPLETED IN FULL to be considered: APPLICATIONS Close Wednesday March 20 th 2015 Please note that this is an application to attend and completing this form does not automatically guarantee you a position on this program. This program will cater for girls 16 to 18 years old and is being delivered from the 8 th to 10 th of April. Applicants Name: Applicants Address: Town/ Suburb: Postcode: Parents Name: Phone: (H) Parents Address: (M) Applicants Date of Birth: Year Level (must be in Year 9 + ) Age Applicants School: State what netball abilities the student above has shown that would recommend her for this experience. Please also state their higher education ambitions and this is the main focus of this program. APPLICANT DETAILS NOMINATION FORM KGI NETBALL PROGRAM 8 th to 10 th April STUDENT REFERENCE this must be completed by someone within your school

Name: Position: Phone: As a nominating person it is clear that you have an important influence on the young person in question. As such we are relying on your relationships with the young person and their family to assist the young person in preparing for the program. We are also relying on your proximity to the young person. As we are based in Melbourne and we have attendees from all around the State, it is impossible for us to provide personal and immediate support – this is where we (and the young person) are relying on you. As the nominating person I understand the following: a)While the KGI/ Neball Vic will do all possible remotely to support the young person, I understand that it is my influence in the form of regular check-ins, speaking to parents, way-laying fears, encouraging etc. at a local level that will be the single most defining aspect of whether the young person actually attends the program. b)It is my responsibility to get the forms filled in correctly and sent in on time. This initial application form will be followed by a registration form for parents to fill out with personal, medical emergency details etc. c)That the transport of the young person to and from camp IS MY RESPONSIBILITY. Whether this be purchasing a train ticket and making sure they get to the station on time, making sure Mum or Dad are driving and that they know where to go or accompanying the young person to Melbourne yourself (car or train). Transport is the single most influential reason for young people pulling out – you need to make sure this is organised and communicated. d)Finally, that the KGI and Netball Vic staff are always available to assist and discuss issues, needs etc. Signed: _____________________________ Print Name: _____________________ Date: _______________ Please return form to our Indigenous Community Engagement Scan and to: Luke Murray: Or mail to: Po Box 48 Richmond, Victoria 3121 NOMINATION FORM KGI NETBALL PROGRAM PERSON NOMINATING STUDENT NOMINATOR’S UNDERSTANDING OF COMMITTMENT