Financial Circumstances Questionnaire

Financial Circumstances Services Questionnaire

Mother's (Guardian) Name*
First Last
Occupation*
Employer Name*
Occupation status*
- Full-time
- Part-time
- Self-employed
- Unemployed
- Pensioner
I am Alumnae of Stuartholme School*
- Yes, I am Alumnae of Stuartholme School
- No
Father's (Guardian) Name*
First Last
Occupation*
Employer Name*
Occupation status*
- Full-time
- Part-time
- Self-employed
- Unemployed
- Pensioner
Personal Statement / circumstances relevant to your financial position*
Student Details
Please provide the details of the student you are applying for the bursary for.

Please list your daughter's details below*

Please ensure you complete a Stuartholme Enrolment Application Form following the completion of the Bursary Application.

Full name	Current School	Year level in 2020	Day Student/ Boarder

Other Children
Include only those children attending school and/or who are below school age and/or are financially dependent.

Please list all children*

To add additional dependants, click on the plus icon to the right.

Full name	School	Year level	Day Student/ Boarder

Are you receiving any discounts or bursaries from other schools?
Family Circumstances
Marital Status*
- Married
- Single
- Divorced
- Separated
- Defacto
- Widow
- Widower
Statement of Financial Circumstances - Household Income
If not applicable, please add $0
Mother's (Guardian) income after tax*
(attach statement of earnings at end of form)
Father's (Guardian) income after tax*
(attach statement of earnings at end of form)
Income of dependents (including Government allowances)*
(attach statement of earnings at end of form)
Government Allowances (including family allowance)*
(attach proof of allowance at end of form)
Pension*
(attach proof of pension at end of form)
Pension type
Other income*
(attach proof of other income at end of form)
Other income type
Total Income
$ 0.00
Statement of Financial Circumstances - Outgoings
If not applicable, please add $0
Outgoings - Mortgage/rental*
Outgoings - Investment/rental income expenses*
Outgoings - Car/transport expenses*
Outgoings - Credit cards/personal loans*
Outgoings - Electricity/gas*
Outgoings - Rates*
Outgoings - Telephone/internet*
Outgoings - Insurance (home, personal, health, car)*
Outgoings - Health (chemist, medical)*
Outgoings - Personal (clothing, entertainment)*
Outgoings - Groceries/household supplies*
Outgoings - Education/school fees*
Outgoings - Other financial commitments*
Statement of Assets and Liabilities
Assets*
Value of House(s) Value of Car(s) Other Assets
Liabilities*
Owing - House(s) Owing - credit cards Owing - other
Supporting documentation
Document upload*
Please include Statements of earnings/payslips for both parents/guardians and proof of any other income.
Drop files here or

Accepted file types: pdf, jpg, Max. file size: 10 MB, Max. files: 6.
Application Declaration
I declare that, to the best of my knowledge, all information provided in the Financial Circumstances Questionnaire and the supporting documents submitted are true and correct and agree that I have a continuing obligation to advise Stuartholme School if there is a change in my circumstances.
I declare that, to the best of my knowledge, all information provided in the Financial Circumstances Questionnaire and the supporting documents submitted are true and correct and agree that I have a continuing obligation to advise Stuartholme School if there is a change in my circumstances.
- Accept
I have read and accept Stuartholme School's Privacy Policy.*
- Accept
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