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