Scholarship Application

Transcription

1 Introduction In keeping with Em s spirit of giving, the Emmy Duff Scholarship Foundation is dedicated to providing scholarships to deserving students. The Scholarships will support post-secondary academic endeavours and recognize the personal triumphs of exemplary students. The $1,500 Emmy Duff Scholarship is a one-time award for full-time students in a college or university program in Canada. Students may be in any year of their studies provided that they are enrolled for school for the 2015 fall term. Eligibility The Emmy Duff Scholarships ($1,500 each) are open to students who: Are currently attending or will be attending a Canadian university or college program for the 2015/2016 academic year. Confirmation of enrolment as a full-time student is required. Are in any year of their studies (must be enrolled for the 2015 fall term); Are resident of and currently residing in Canada; Have demonstrated an ongoing volunteer commitment to causes that are important to them; and Have undergone treatment or are currently being treated for cancer. Required Documents Completed application form. Only 2015 application forms will be accepted. Statement from your oncologist or current physician confirming that you were treated (or are currently receiving treatment) for cancer word letter describing your personal life experience, your future goals and why you feel you are a candidate for an Emmy Duff scholarship. Letter of acceptance from the Canadian post-secondary institution you will be attending in September Deadline for Submission Monday, June 15, 2015 (Applications received after this date will not be accepted). Questions? For more information about the Scholarships, please scholarships@emmyduffscholarship.org

2 Application Process the required documents as one (1) pdf file to Mark the subject line of the as 2015 Scholarships Your Name All applications are due not later than Monday, June 15, 2015 at 5 PM EST All applicants will be notified in August 2015 about the status of their application Scholarship cheques will be issued to the college or university once confirmation of full-time enrolment in your post-secondary program and proof of fees paid has been received by us Adjudication Applications will be reviewed by the Board of the Emmy Duff Scholarship Foundation.

3 Student s Personal Information First Name: Last Name: Initials: Gender: Address: Telephone: Female Male Home (Permanent) Address: Home: Cell: Unit/Apt.: City: Province: Postal Code: Date of Birth (Month/Day/Year): Student s School Information Name of College or University: Degree Program: Year of Study (as of Sept. 2015): Proof of Enrollment: Please attach verification of the college or university you will be attending in September 2015 (such as a copy of the letter of acceptance). Proof of enrollment will be required once the Fall term has begun. Cancer Treatment Story Type of cancer (please be specific): Age at diagnosis: Are you currently receiving treatment? Hospital of treatment: Name of Oncologist: Name of Nurse: Name of Social Worker: Applicants must also attach a letter, to support their application, from their oncologist, current doctor or a member of their oncology health care team (i.e. social worker, nurse, etc) confirming that applicant was treated, or is currently being treated, for cancer.

4 Information on volunteer work including why you chose this cause (if you have more than one position/organization of volunteer experience please append an additional page to your application form): Name of Organization: Time period of volunteer work: Description of volunteer work: Responsibilities undertaken in your volunteer activites: Why you chose this volunteer activity: Reference: Name, Phone number, Personal Statement Letter: The Personal Statement letter addressed to the Foundation should describe yourself (including your interests and activities), your future goals and why you feel you are a candidate for an Emmy Duff scholarship. Please append your letter to your application.

5 I hereby declare that all information given on this application is true and complete in every respect. I understand that I may be required to repay all or part of the award if the information is found to be inaccurate for any reason. I hereby acknowledge that in furtherance of the application herein contained, I have been requested to provide certain personal information to the Emmy Duff Scholarship Foundation and that I may subsequently be requested to provide additional information. I further acknowledge that the Emmy Duff Scholarship Foundation may make enquiries in respect of the information contained in this application from the parties listed herein. I consent to the collection, use and disclosure of such personal information as may be required by the Emmy Duff Scholarship Foundation from time to time in the course of its business, including, without limitation, for purposes related to the decision to grant or deny a scholarship. 1 I hereby acknowledge that for purposes of the Foundation s website, its annual newsletter and other material provided to the Foundation s donors and potential donors, I consent to the use of certain personal information contained in this application. I also agree to provide the Foundation with a digital photo (jpeg) of myself that may be included on the Foundation s website and/or in the Foundation s annual newsletter. Student Name (printed) Signature Date We would like to know how did you hear about the Emmy Duff Scholarship Foundation? If more than one applies, please check as well. Childhood Cancer Canada Hospital Social Worker/Nurse Young Adult Cancer Canada (YACC) Teen Connector Website Support Group Social Media (Facebook/Twitter) Other (please specify): Leukemia & Lymphoma Society 1 This acknowledgement is requested pursuant to applicable Canadian privacy legislation.

6 Application Checklist (Do not send in this page, keep for your records): Completed application Scholarship Application Letter from oncologist or current doctor or other member of oncology health care team confirming you were treated or are currently being treated for cancer Personal statement letter to the Foundation Proof of enrolment from the post-secondary institution you will be attending in September 2015, such as a Letter of Acceptance Documents to be sent as one (1) PDF file to scholarships@emmyduffscholarship.org by Monday, June 15, 2015 Note: Confirmation of enrollment at your post-secondary institution and proof of fees paid will be required once school starts in the fall of For any inquiries, please contact scholarships@emmyduffscholarship.org Thank you for applying for a 2015 Emmy Duff Scholarship