Leeuwin Youth Explorer Voyage Application

Applicant Details

Title

First Name*

Last Name*

Street Address*

City*

State*

Postcode*

Email*

Phone*

Date of Birth*

Emergency Contact*

School*

Have you sailed on Leeuwin before?*

YesNo

Which Voyage do you want to participate in?*

15 to 21 December 2023. Departing from Fremantle, arriving in Fremantle.
1 to 8 April 2024. Departing from Fremantle, arriving in Shark Bay.

How did you hear about the Leeuwin scholarship?*

Reference

Please ask someone who has known you for at least two years to complete the section below eg your teacher or employer (not a family member).

Title

First Name*

Last Name*

Mailing Address

Relationship to applicant*

Financial Contribution

Youth Explorer Voyage costs without a subsidy $2,375. Leeuwin voyages are subsidised by the Shire of Harvey’s Leeuwin Sail Training Trust. You are required to contribute a minimum of $400 towards the trip. If successful, this contribution must be paid to the Shire of Harvey by Thursday, 13 October 2023.

Applicants must organise and fund their own transport to the port.

Amount of contribution*

(Minimum $400 for Youth Explorer Voyage)

Creative Contribution

Please describe why you would like to sail on the STS Leeuwin II*

Declaration

I have read and I understand the guidelines of this application and declare that:

The information given in this form is complete and correct.
I am aware that this application is for a scholarship and my booking confirmation is conditional on acceptance by the Community Sail Training Trust Advisory Group and the Leeuwin Ocean Adventure Foundation’s approval.
I have read and I understand the Application Guidelines.
In the event that I am successful in my application, I agree to pay the required contribution to the Shire by Thursday, 13 October 2023.

Please agree.

If you are under the age of 18, your parent or guardian must complete the section below.

I understand the Application Guidelines set out above and give consent to the applicant of this form to apply to the Shire of Harvey Leeuwin Sail Training Trust subsidy for a voyage on the Leeuwin II.

Please agree.

Name of Parent / Guardian*

Date*

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