Give It Back Scholarship Program

JFL Foundation

Give it Back Scholarship Program

Dear applicant,

We are pleased that you have an interest in the Give Back Scholarship Program, and we hope that you will find the application process quite simple. There are several important aspects to the application process that we would like to bring your attention to:

To be eligible, you must be an underprivileged individual, meaning someone who:

Currently has little means of support;or
Is unemployed or is facing a real prospect of imminent unemployment and is shown to need assistance.

Scholarships are provided to students from low income families.

We expect that students will work 5 to 10 hours per week to cover some of their personal expenses.
This application is for the fall semester of academic year 2014 – 2015 or after.
Answers shall be typed into the Give it Back Scholarship Application Form.
Please ensure all of the information noted below is sent with your application to facilitate the review process:
The Give it Back Scholarship Application Form duly completed.
If you are between the age of 18 and 30, we will need copies of the most recent bank statements, investment slips and pay slips of your parents to assess your inability to pay for education fees.
A recent passport size color photograph of the applicant.
A photocopy of the first page of your passport or official identification card.
A photocopy of the most recent transcript of grades.
When the grading system used in the transcript of grades is different than a percentage of 100, we require a statement from the education institution that explains the grading system if not provided on the transcript.
Two letters of recommendation from unrelated parties, with their name, position, phone number and email address.
Your application shall be sent in PDF format to:
The selection process is determined based on each applicant’s overall profile and the strength of their application.
Due to limited funding, we may not be in a position to provide you with a positive response at this time. However, if your application responds to our criteria, we will be keep your name on a waiting list as you may be eligible for funding at a later time. In such instance, you will be requested to submit a revised application with updated information.
Each of our selected students becomes part of the JFL family. We believe in the wonderful ripple effect of an act of kindness. For this reason, we require that our scholars give back to their communities during their life time through the provision of discretionary financial support to meet someone else’s educational needs.

We look forward to receiving your application. We wish you all the very best.

Kind regards,

Jocelyne Lafrenière

President & CEO

JFL Foundation

Application for Admission to the Give Back Scholarship Program

Full legal name: Mr. Ms.

(Your name shall be as it appears on passport or identity card.)

Last Name:

First Name:

Gender: Male Female
Date of birth (ex. 9 June 1980)

Day, Month, Year:

Under Privileged Status

Currently has little means of support

Unemployed or is facing a real prospect of imminent unemployment and need assistance

Nationality

(Indicate nationality as it appears on your passport or official ID card presented with this form.)

Nationality:

Country of birth

Country of birth:

Current mailing address

(A complete and valid address is mandatory.)

Street number and Street Name:

City:

Province or State if applicable:

Country:

Postal code:

Permanent address

(Complete only if different from # 7 above.)

Street number and name:

City:

Province, if applicable:

Country:

Country Area code:

Phone number

Telephone (home):

Cell phone:

9. Email address

Email address:

Name of vocational training, college, university program of interest

(Please indicate in the comment section if you need to attendcollege first and then university once you have obtained your college degree.)

Vocational training (not provided at a college):

College program:

University program:

Comments:

Duration of the program

(If you need to attend college first and then university, please indicate how many years of college and how many years of university are required.)

Vocational training: One year  two years three years  four years 

College: One year  two years three years  four years 

University: One year  two years three years  four years 

Comments:

Names of education institutions located in your country that deliver the chosen program

(If the program is not delivered in your country, please indicate nameand address of institutions that deliver the program in a close by country.)

Vocational training (not provided at a college):

Name and address of Institution:

College:

Name and address of Institution:

University:

Name and address of Institution:

Have you applied to one or more Institutions?Yes No
Have you been accepted by an Institution?Yes No

If yes, which one and when?

Expected costs of the education program

(Add additional columns if the education program spans over more than four years.)

(Note that each year, we will ask you for a revised table of education costs in order to be provided with more accurate estimates.)

Vocational Training (not provided at a college):

Year 1 / Year 2 / Year 3 / Year 4 / Grand Total
Sept 2014 to Aug 2015 / Sept 2015 to Aug 2016 / Sept 2016 to Aug 2017 / Sept 2017 to Aug 2018
Tuition Fees
Food
Uniforms
Transportation to education facility
Accommodation
Supplies
Books
Computer equipment (only if required)
Medical insurance
Stipend (spending money for small personal expenses)
Total Education Costs

College:

University:

Year 1 / Year 2 / Year 3 / Year 4 / Grand Total
Sept 2014 to Aug 2015 / Sept 2015 to Aug 2016 / Sept 2016 to Aug 2017 / Sept 2017 to Aug 2018
Tuition Fees
Food
Uniforms
Transportation to education facility
Accommodation
Supplies
Books
Computer equipment (only if required)
Medical insurance
Stipend (spending money for small personal expenses)
Total Education Costs

Positions that you have held and names, addresses and phone numbers of employers by chronological order (from the most recent to the less recent)

Name of employer, address and phone number:

Position:

Inclusive dates:

Name ofemployer, address and phone number:

Position:

Inclusive dates:

Name ofemployer, address and phone number:

Position:

Inclusive dates:

Name of employer, address and phone number:

Position:

Inclusive dates:

Name ofemployer, address and phone number:

Position:

Inclusive dates:

Family situation

(This information is needed to assess your inability to obtain family assistance and your need of financial assistance.)

Number of brothers, sisters and other dependents living at home
Monthly gross salary of father
Monthly gross salary of mother
Family monthlyrent
Family monthly debt (mortgage and other debts)
Current bank and investments balance of parents (father and mother)

Are you in a position to work part time (some evenings or week-ends to cover some of the education costs? Yes No

If yes, how much do you expect to earn each year? Complete table below.

Year 1 / Year 2 / Year 3 / Year 4 / Grand Total
Sept 2014 to Aug 2015 / Sept 2015 to Aug 2016 / Sept 2016 to Aug 2017 / Sept 2017 to Aug 2018
Revenues from part-time employment

Other sources of education funding

Please specify:

Yes / No / Name of Donor
Government student loan
Government scholarship
University scholarship
University scholarship
Foundation or other non-profit organization scholarship
Other awards and scholarship
Family loans
Family gifts
Other

Total anticipated sources of funding indicated under tables 18 and 19

(Note that each year, we will ask you for a revised table of funding sources to provide us with more accurate estimates.)

(Add additional columns if the education program spans over more than four years.)

Vocational Training (not provided at a college):

Year 1 / Year 2 / Year 3 / Year 4 / Grand Total
Sept 2014 to Aug 2015 / Sept 2015 to Aug 2016 / Sept 2016 to Aug 2017 / Sept 2017 to Aug 2018
Part-time employment
Government student loan
Government scholarship
University scholarship
University scholarship
Foundation or other non-profit organization scholarship
Other awards and scholarship
Family loans
Family gifts
Other
Total

College:

University:

Financial support required from the JFL Foundation to meet your education costs

(This is expected to be the difference between revenues shown in table 20 and expenses indicated in table 15.)

(Add more years if the education program (college, university) spans over more than four years.)

Vocational training (not provided at a college):

Year 1:

Year 2:

Year 3:

Year 4:

College:

Year 1:

Year 2:

Year 3:

Year 4:

University:

Year 1:

Year 2:

Year 3:

Year 4:

Government secondary school certificate (or high school diploma) held. Please indicate name of certificate, date received and overall grade

Name of certificate:

Date received:

Overall grade:

List of your academic distinctions, awards, or prizes that you have received

List of articles published to date in newspapers and magazines

25.Proficiency in languages

(Indicate whether you are excellent, good, fair, no knowledge)

Writing / Reading / Speaking
English
French
Other (specify)
Other (specify)

26. Personal Statement

(Take note that your personalstatement is an important component of your application. An answer of approximately 60 to 100 words to questions 2 to 6 is acceptable. Question 1 may be answered in less words)

State your current career objectives

How do you expect that the selected education program will enhance your career options?

What is your willingness to learn and complete the program of your choice?

How will the program allow you to give back to the community?

How are you currently a role model in your day-to-day life?

How will the program allow you to be a role model?

27. Personal declaration

I certify that the information provided in this application is, to the best of my knowledge, complete and accurate.

Yes No

I understand and agree that the JFL Foundation or its representative have the right to conduct at its expense an audit or review, as may be considered necessary, of the financial information provided in this application and in the revised tables of costs and funding submitted each year.

Yes No

I further understand that misrepresentations or material omissions made in this application render me morally and legally liable to excess funding received from the JFL Foundation.

Yes No

I understand that the Give it Back Scholarship Program is a give back program under which I commit to provide discretionary financial support to meet someone else’s education needs. I agree to inform the JFL Foundation of my contribution.

Yes No

I understand that tuition fees are paid directly to education institutions. If I am provided with an initial living allowance, I agree to submit evidence of successful completionof semesters’ courses in order to receive subsequent living allowances.

Yes No

I authorize the JFL Foundation to feature on its website my name, country of residence, chosen program and education institution, testimony and contribution received.

Yes No

Date:

Signature: