CHSQ 2017-2018

DavidPouliot Scholarship Program

With the contribution of our financial partners, the CHSQ offers all those affected by a bleeding disorder the possibility to obtain a scholarship for the 2017-2018 academic year in two categories.

Goals of the scholarship and bursary program

  • Encourage young people living with a bleeding disorder to continue their collegial, university or vocational studies
  • Encourage people with a bleeding disorder to return to school or follow a continuing education course in their field.

Description of the two categories

Academic scholarships

Scholarships are intended for members who have a bleeding disorder and studying at the collegial or university level, or at a vocational institution.

Mature student bursary

This category includes members with a bleeding disorder wishing to return to school, to take continuing education classes in their field or to begin a course of studies at any level.

Admissibility criteria for the various categories

  • Be a Quebecer living with a bleeding disorder
  • Be a member of the CHSQ
  • Be a student in a recognized collegial, university or vocational institutionORbe registered in a recognized academic institution so as to return to studies or be registered or intend to register for a vocational course.
  • Have received no more than two consecutive bursaries or scholarships in the past three years

The deadline for submission of completed applications is midnight, November 7, 2017.

The submission application (pages 3 to 7)and supporting documents must be sent to: Canadian Hemophilia Society – Quebec Chapter, DavidPouliot Scholarship Program, 514 - 2120 Sherbrooke East, Montreal, QC, H2K 1C3

GENERAL INFORMATION

Documents for all applicants to supply

  • The completed application form included in this package
  • A recent photo (high resolution quality)
  • Up-to-date curriculum vitae
  • Proof of Canadian citizenship and Quebec residency

Documents to supply according to category

Applicants for an academic scholarship:

  • A letter from your treating doctor or a representative of the medical profession confirming that your medical status meets the criteria for admission to the program
  • Proof of registration at a collegial, university or vocational institution
  • Official transcript of final scholastic year completed; this can be returned upon request
  • Three (3) letters of recommendation no more than two years old with at least one written by a teacher. These letters must attest to the ability and suitability of the applicant for the chosen program, as well as a character reference. A letter from a relative will not be accepted, unless the student has worked or is working for this person.
  • A 500-word essay on the following subject: “Describe how your bleeding disorder and the CHSQ have had an influence on your academic and/or professional development. “

Applicants applying for a mature student bursary:

  • A letter from your treating doctor or a representative of the medical profession confirming that your medical status meets the criteria for admission to the program
  • Proof of registration at a collegial, university or vocational institution (if registration depends on you receiving this bursary, you can supply this document between now and the end of 2017).
  • Three (3) letters of recommendation no more than two years old. These letters must attest to the personal and professional suitability of the applicant. A letter from a relative will not be accepted, unless the applicant has worked or is presently working for this person.
  • A 500-word essay explaining the applicant’s motivation for taking a professional course or for returning to academic studies.

Application form

Section A: Personal information

Family name: First name:

Address: (number and street)

City: Province: Postal code:

Telephone: (Home)(Work/cell):

E-mail:

Date of birth:

Mailing address (if different from above):

Number and street:

City:Province:Postalcode:

Application form

Section B: Choice of institution

Name of applicant:

Option A:

If you are already studying at a CEGEP, university or vocational institution, please supply the following information:

Name of the institution:

Program of studies:

Faculty (if relevant):

Option B:

If you wish to register for the first time at a CEGEP, university or vocational institution, please enumerate, in order of preference, the three institutions to which you have applied:

1st choice

2nd choice

3rd choice

Application form

Section C: References

Name of applicant:

Names and coordinates of people who signed letters of reference (these must be included with the application):

  1. Name:

Address:

(Number and street)

(City)(Province)(Postal code)

  1. Name:

Address:

(Number and street)

(City)(Province)(Postal code)

  1. Name:

Address:

(Number and street)

(City)(Province)(Postal code)

Application form

Section D: Volunteer and community involvement

Name of applicant

Please state, in order of importance, three important school, professional or community activities in which you have been involved in the past three years. In one sentence, explain why they were important to you.

  1. Activity and duration of your participation

Your job, role or position:

Comments:

  1. Activity and duration of your participation

Your job, role or position:

Comments:

  1. Activity and duration of your participation

Your job, role or position:

Comments:

Application form

Section E: Essay

Name of applicant:

Please include an essay of approximately 500 words that meets the requirement as defined for the scholarship or bursary category (see page 2 of this document).

Name of applicant:

Control list for applicants

For all applicants:

Completed form □

Essay (if not included in Section E of this form) □

Recent photo (high resolution for publication) □

Up-to-date curriculum vitae □

Three (3) letters of recommendation no more than two years old □

Applicant for an academic scholarship:

Letter from your treating physician □

Proof of registration in an institution □

Official transcript of marks from the final scholastic year completed □

Applicant for mature student bursary:

Letter from your treating physician □

Proof of registration at an institution or in a vocational course (if available) □

For applicants borne outside Quebec or Canada:

Proof of residence in Quebec and Canadian citizenship □

1/8

CHSQ Scholarship application 2017-2018