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2024 Mitsui Scholarship Enquiry Form
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Email
*
Your email
First Name
*
Your answer
Surname
*
Your answer
Preferred name
Your answer
Gender
*
Male
Female
Other:
Date of Birth
*
MM
/
DD
/
YYYY
Phone
*
Your answer
Address
*
Your answer
Parent Information
Parent Name
*
Your answer
Parent Email
*
Your answer
Parent Phone
*
Your answer
School Information
School Name and School Year you're currently in
*
Your answer
What are your average school grades?
*
Your answer
What are your school subjects?
*
Your answer
Health Information
Do you have, or have you had, any illness or disability that has caused hospitalisation in the last three years? If yes, please explain.
Your answer
Do you currently take any medication? If yes, please list the name/s and reason/s for the medication.
Your answer
Do you have any allergies or dietary requirements? If yes, please explain
Your answer
Permanent employees of Mitsui Resources Pty Ltd joint venture -
What mine does your parent work in?
*
Capcoal
Dawson
Kestrel
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A copy of your responses will be emailed to the address you provided.
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