DONALD R. SOBEY FAMILY SCHOLARSHIP APPLICATION

Transcription

1 17 DONALD R. SOBEY FAMILY SCHOLARSHIP APPLICATION DEO REGI LEGI GREGI PERSONAL INFORMATION LAST NAME FIRST NAME MIDDLE INITIAL Office Use Only: B00 PREFERRED NAME GENDER FEMALE MALE DATE OF BIRTH (D/M/Y) PLACE OF BIRTH CANADIAN CITIZEN/ PERMANENT RESIDENT? YES NO MAILING ADDRESS/STREET CITY PROVINCE POSTAL CODE HOW MANY PEOPLE LIVE IN CITY/TOWN? PRIMARY TELEPHONE ADDRESS LANGUAGES SPOKEN AT HOME PREFERRED LANGUAGE OF COMMUNICATION ENGLISH FRENCH HOW MANY SISTERS DO YOU HAVE? OLDER YOUNGER HOW MANY BROTHERS DO YOU HAVE? OLDER YOUNGER MOTHER OR GUARDIAN LIVING DECEASED FATHER OR GUARDIAN LIVING DECEASED OCCUPATION OCCUPATION EDUCATIONAL INFORMATION: Please describe your academic interests and strengths: I certify that the information provided on this application form and in the accompanying documentation is true, accurate and complete. SIGNATURE DATE 1

2 ACTIVITY RECORD STUDENT NAME 1. Please list all activities in which you have participated since September 2013, including those in your current academic year. Please indicate your role in each year you participated. School & Community Service: For example: Yearbook - Video Editor, Multicultural Club-Participant, etc. - Artistic/Musical: Put S for school activities; P for private lessons; C for community activities, and I for independent pursuits. NOTE: If you were a section leader or concert/choir master, please add SL (for section leader) or CM (for concert/choir master). - Competitions / Conferences / Special Programs: - Athletics: Put S for sports in which you represented your school in interscholastic competition; put HL for house-leagues or intramurals; put T for club sports within your community. NOTE: If you were a Captain of a team, please put C EMPLOYMENT / ENTREPRENEURIAL - Please list your current and previous employment: EMPLOYER POSITION FROM (MM-YYYY) TO (MM-YYYY) AVG HRS/WK 3. HOBBIES - List up to five: 4. AWARDS/DISTINCTIONS - List up to three: 2

3 ACTIVITY RECORD STUDENT NAME 5. Please list, in order of importance to you, up to four school or community activities in which you have invested significant energy in the last three years, and state your contribution to them. Be sure to include approximate hours per week and the start and end dates (MM-YYYY) for each activity. A) ACTIVITY / ROLE HRS/WK B) ACTIVITY / ROLE HRS/WK C) ACTIVITY / ROLE HRS/WK D) ACTIVITY / ROLE HRS/WK 6. ABOUT YOU - List five things you ve done that, taken together, tell people who you are. I) II) III) IV) V) 7. COMMUNITY SERVICE-please check box(es) if you were required to complete community service or extracurricular activities as part of your: Secondary School Diploma Post-Secondary Acceptance Course Course Other Total Hours Required 3

4 SHORT ESSAYS STUDENT NAME 1. Describe what you consider to be your most significant volunteer contribution to date in terms of its value to your school or larger community. Why was it important to you and to others? 2. Describe a time you challenged yourself by taking on a task/project you felt was beyond your scope and capability at the time. Why did you do it? How did you overcome the obstacles? 4

5 STUDENT NAME 3A) Please list up to three significant leadership roles where you managed others. LEADERSHIP ROLES # OF PEOPLE DIRECTLY MANAGED HRS/WK START/END DATES I) II) III) 3B) Using one of the leadership roles listed above, describe how you led a group of people towards a common goal. Using concrete examples, how did you engage others? What difficulties did you encounter? What were the outcomes? 4. Describe a time when you took the initiative to address an unmet need at school or in the community. What was the need and what steps did you take? What were the results of your actions? 5

6 VERIFICATION AND ENDORSEMENT 1. Activity Verification: I have examined the applicant s activity pages (2 and 3 on this application), and I attest that they accurately describe the applicant s activities to the best of my knowledge. NAME OF SCHOOL OFFICIAL OR COMMUNITY REPRESENTATIVE TITLE AND ORGANIZATION SIGNATURE 2. Reference: Please provide the name and of a reference who may be contacted during the selection process. Choose someone who is not a relative or friend but who knows you and your activities well. NAME OF REFERENCE TITLE AND ORGANIZATION 6