Lougheed Area Bursaries

LOUGHEED AREA BURSARIES

APPLICATION FORM

Please make sure you meet the criteria for the bursary/bursaries you are applying for (see Information sheet).

I AM APPLYING FOR THE:
o LOUGHEED AREA BURSARY o DONNA KAYTOR BURSARY o PADDY MANTLE BURSARY

Please type or print neatly with a dark coloured pen.

iMIS #: ________________________ DISTRICT: ______________________________________

APPLICANT: ____________________________________ ________________________________________

(Surname) (First name)

ADDRESS: ______________________________________________________________________________

(Number) (Street) (City/town) (Postal code)

TELEPHONE: ___________________________________ DATE OF BIRTH: D ______ M ______ Y ______

SIN #: _________________________

HAVE YOU BEEN AN ACTIVE MEMBER OF LOUGHEED AREA GIRL GUIDES FOR THE PAST 3 YEARS?

o YES o NO

ARE YOU EMPLOYED? ________ ON AVERAGE HOW MANY HOURS/WEEK DO YOU WORK? ________

CURRENT SCHOOL (if applicable): _______________________________ PRESENT GRADE: ___________

PROPOSED INSTITUTION(S): _______________________________________________________________

Please answer the following:

Ø Give details of your service and volunteer involvement in Guiding:

Ø Give details of your service and volunteer involvement outside of Guiding:

Ø Personal interests and activities:

REFERENCES:

Please provide the names and contact information of the two people (not relatives) who are providing references on your behalf:

In Guiding

Full name: District:

Position currently held: # years known:

Telephone: _________________________________ Email: _______________________________________

Non-Guiding

Full name: ______________________________________________________________________________

How you know one another (Organization/Relationship): ___________________________________________

Position: # years known:

Telephone: _________________________________ Email: _______________________________________

I have enclosed the following documents:

1. A letter of 300 - 500 words on "How Guiding has enriched my life and influenced my future plans".

2. Two letters of reference.

DEADLINE FOR APPLICATION AND ALL SUPPORTING DOCUMENTS:

5:00 PM ON MAY 15TH

LATE APPLICATIONS WILL NOT BE CONSIDERED

Complete this application form and mail to: Girl Guides of Canada - Lougheed Area Bursaries

C/O Laura Nicolai

21508 Berry Ave.

Maple Ridge, BC V2X 2C8

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