BISHOP ALLEN ACADEMY

SCHOLARSHIP APPLICATION PACKAGE

Name:
E-mail Address: / Volunteer Hours Completed: Yes No
How many total to date: ______
Ethnic Origin (some scholarships require this info): / Physical Disability/ Handicap: Yes No
If Yes, please describe.
Does your family qualify as low or middle income? (see bottom of page 3)
Low Middle / Describe any serious hardships(chronic illness or deaths in family, need to work to contribute to family’s expenses, etc) that may have affected your academic achievement to date.

Academic Excellence:

Grade 11 Average: ______

Briefly outline career goals:

I am planning to apply to the following universities or colleges (rank in order of preference):

UNIVERSITY / PROGRAM

RELEASE OF INFORMATION: I permit all information on these sheets to be used within the school by staff involved with scholarship applications.

______

SIGNATURE

For Office Use Only- Date Submitted: ______

Scholarship Application Package Page 1 of 5 Updated: Sept 2017

A. AWARD OF DISTINCTION (i.e. MVP/MIP, Team Captain, Honour Roll, Subject Award etc.)

AWARD/ DISTINCTION / YEAR (S)

B. EXTRACURRICULAR PARTICIPATION (NON-LEADERSHIP)

CLUB/ GROUP/TEAM / YEAR (S) / NUMBER OF HOURS / MODERATOR’S
NAME

Scholarship Application Package Page 2 of 5 Updated: Sept 2017

COMMUNITY INVOLVEMENT / YEARS (S) / NUMBER OF HOURS / MODERATOR’S
NAME

The Government of Canada’s Canada Student Grants program defines “financial need” according to the following thresholds:

SIZE OF FAMILY / LOW INCOME / MIDDLE INCOME
1 person / $30,000 / $61,513
2 persons / $42,426 / $86,031
3 persons / $51,962 / $102,638
4 persons / $60,000 / $112,817
5 persons / $67,082 / $122,229
6 persons / $73,485 / $131,177
7 or more persons / $79,373 / $138,897

Scholarship Application Package Page 3 of 5 Updated: Sept 2017

C. STUDENT LEADERSHIP (SCHOOL OR COMMUNITY)

CLUB/ GROUP/ TEAM / LEADERSHIP
ROLE / YEAR (S) / NUMBER OF HOURS / MODERATOR’S
NAME

D. WORK EXPERIENCE

Name of Employer / Duties / Hours (Weekly) / Supervisor’s Name

E. Other awards, distinctions, experiences, or merits not covered by the above that you want to bring to the attention of the Scholarship Committee.

Scholarship Application Package Page 4 of 5 Updated: Sept 2017

E. Prepare and attach a one page response(typed) to one of the following:

Describe your most significant achievement to date and why you feel it is so ORdescribe a difficult leadership situation you faced and how you overcame it.

F. Please sign below your agreement and a parent/ guardian agreement for Bishop Allen Academy to acknowledge, publicly, your success in attaining a scholarship in a suitable manner (i.e. P.A. announcement, website announcement, notice board, newsletter, local newspaper, etc.)

Student Signature: ______

Parent/Guardian Signature: ______

Date: ______

Scholarship Application Package Page 5 of 5 Updated: Sept 2017