Applicant Details

First Name *

Date of Birth *

Address *

Email Address *

Phone Number *

Are you an Australian citizen or permanent resident? *

YesNo

Employment / Industry Experience

Current employment status *

Employed Full TimeEmployed Part TimeEmployed CasuallyUnemployedOther

Employer/ Organisation

Current Position

Relevant experience in viticulture, agriculture, or related fields *

Personal Statement

Please answer the following questions in 150–300 words each.

Why are you interested in studying the Diploma of Viticulture? *

What are your career goals in the wine or viticulture industry? *

How will receiving this scholarship support your studies and future aspirations? *

Referees

Referee 1

Referee 2

Full Name *

Relationship *

Contact Number *

Declaration

I declare that the information provided in this application is true and correct. I understand that providing false or misleading information may result in my application being disqualified.

I acknowledge the above information is true and correct *

I wish to receive correspondence from GOTAFE about relevant courses and study options

I wish to receive correspondance/ marketing from Wine Australia

Signature

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Date *

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