Form 5 Youth Scholarship Application From

Form 5 – Youth Scholarship Application From

www.gaysurrey.com

OIS “Rainbow Spirit” Scholarship Application Form 2007

First Name ______

Last Name ______

Requirements:

Applicant must be under the age of 25 and a member/participant of the Surrey Youth Alliance or other qualified youth or community organization. i.e GLBT organization

Indicate which of the above: ______

Applicant must be a permanent resident of Canada or a legal Canadian Citizen

Please provide official confirmation of acceptance in a post-secondary educational program.

The Scholarship will be made payable to the recipient. Please also provide proof of tuition fees paid to the institution.

Application Deadline Date: September 5th 2007

Please Sign and Date Application

Student/I.D # ______Birth Date: ______

Mailing Address ______

City ______Prov: ______

Postal Code ______

Telephone ______E-Mail: ______

Post-secondary institution:

Name: ______

Address: ______

City: ______Prov: ______

Postal Code: ______Telephone: ______

Please give detailed community involvement including non-paid activities for the past 12 months

______

______

Please give a brief description as to the choice of the post-secondary education you have chosen

______

Do you see community involvement continuing as you further or complete your education? If yes, please explain:

What do you see as your career choice after finishing your education?

Do you plan on being involved in Youth Oriented Activities as an advisor on Education opportunities for the future of the GLBT Youth in the area?

Please provide us with 2 references, of adults not related or living with you, ie teacher, principal, counsellor etc. so that we might contact them to enable us make the final decision.

Name ______Name______

Address ______Address ______

______

Occupation______Occupation ______

Tel Number ______Tel Number ______

Relationship to you ______Relationship to you ______

******************Please TYPE a brief – no more than 100 words – description of yourself that would help us to make this decision in your favor below.

Those selected will be asked to attend Coronation of the Imperial Sovereign Court of Surrey on Saturday September 29th 2007

______

Signature Date

Mail to:

OIS Rainbow Cultural Society E-Mail:

P.O.Box 22

10688 King George Hwy

Surrey, BC Canada

V3T 4W4 Tel No: (604) 657-4991