Dave Robertson Award 2008

Application Form

Personal Information

Mr Ms

Surname First Name Initials

Street address City Province Postal Code Telephone

Student ID Number Birthdate E-mail address

Citizenship Status

Canadian Citizen Permanent Resident

Faculty Information (must be entering Third year)

Program: Geology Geophysics Honors Specialization Year of Program

University of Alberta - 4 - Dave Robertson Award

Postsecondary Information (Please list all universities and colleges attended.)

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Institution Location From To

1. 
2. 

Employment Information (Please list all employers/positions.)

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Employer/Position Location From To

1. 
2. 

Additional Information

Please list any University of Alberta Scholarships/Awards you have been awarded and the year they were awarded:

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Award Year Amount

Extracurricular Activities
Please complete the remaining questions in detail as they will be a determining factor in the outcome of the competition.
Note: Highlight your best accomplishments first.
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1. University Activities (Please include a detailed description.) /
Start date/end date / Activity / Estimated number of hours spent in this
activity per week and number of years/
months served.
Do not list paid positions. /
2. Community Activities (Please include a detailed description.) /
Start date/end date / Activity / Estimated number of hours spent in this
activity per week and number of years/
months served.
Do not list paid positions. /
3. Paid Leadership Positions (Please include a detailed description.) /
Start date/end date / Activity / Estimated number of hours spent in this
activity per week and number of years/
months employed. /

University of Alberta - 4 - Dave Robertson Award

In a paragraph of 300 words or less, please describe why you deserve the Dave Robertson Award and include information about yourself and your activities that demonstrate your passion for geology/geophysics as well as your leadership. Type your answer in the box below.

Describe your Future Plans in the box below.

Letters of Reference

You must provide two letters of reference with your application. Provide the instructions below to your referees and ask them to return their reference letter to you in a sealed envelope.


Declaration:

I certify that the information contained in this application is complete and correct. I authorize the Selection Committee to access my academic transcripts and contact my referees if necessary. I further authorize the Student Awards Office, if necessary, to report my name, address, program, and award status to the donor(s) of this award and to use my name in various public relations publications, presentations, and announcements to promote the University and its awards programs.

The personal information requested on this form is collected under the authority of section 33(c) of Alberta’s Freedom of Information and Protection of Privacy Act to determine your eligibility for scholarships and awards. Certain personal information may be made available to federal and provincial departments and agencies under appropriate legislative authority. For further information, contact the Assistant Registrar, Student Awards, Student Awards Office, 1-80 Students’ Union Building, University of Alberta, Edmonton, Alberta, T6G 2J7; phone (780) 492-3221.

Signature Date

______

Along with this application I enclose two (only) letters of reference in sealed envelopes from persons who can speak specifically to my leadership abilities and my passion for geology/geophysics.

Print, sign and return the completed application by October 1 to: Undergraduate Program Administrator

Earth and Atmospheric Sciences

1-26 Earth Sciences Building

University of Alberta

Edmonton, AB T6G 2E3


Instructions for Referees

You have been asked to provide a letter of reference for the University of Alberta David K. Robertson Award in Geology and Geophysics. You should be familiar with the applicant’s university or community/participation, sports activities, or cultural or political involvement. Please focus your comments on the leadership qualities and activities of the applicant and feel free to provide comments on the student’s motivation, industriousness, and judgment. Your comments will be treated as confidential. Please keep your comments to one page.

Reference letters should be typed, signed, and dated. The following information should appear at the top of your letter:

● Name of applicant

● Your name

● Your phone number

● Your occupation/position and place of work

● Your relationship to applicant (how you know him/her)

● Length of time you have known the applicant

University of Alberta - 4 - Dave Robertson Award