Rotary Club of Barrie-Huronia
Post Secondary Entrance Bursary Application
Personal Information
Name:______Date of Birth:______
SIN: ______Marital Status: ______Dependents _____
Emergency Contact(s)(Relationship):______
Permanent Address: ______
Phone: ______Email:______
TemporaryAddress: ______
Phone: ______Email:______
Program Information
Name of secondary school: ______
Year of graduation: ______Final Year average______
Please attach a copy of latest course and mark summary.
Name of recent guidance counselor/teacher: ______
Academic year applying for: ______
Name of Post-Secondary institution: ______
Program of Study: ______
Expected Year of completion: ______Degree or diploma: ______
Career you hope to pursue:______
Estimated Expenses for Academic Year
Total tuition fee per year: ______
Books, tools, instruments: ______
Residence/Room and Board: ______
Transportation: ______
Other (specify) ______
Total Expenses: ______
Financial Resources
Have you applied for an Ontario student program: ______
Amount of expected or approved loan: ______Grant: ______
Name of all scholarships/bursaries you will or expect to receive:
Sponsor: ______Amount: ______
Sponsor: ______Amount: ______
Sponsor: ______Amount: ______
Employment Income: Part-Time ______Seasonal ______Summer______
Amount you expect to contribute toward school costs ______
Total combined income of parents/guardians from the previous tax year (all sources): ______
Number of dependents they support: ______
Additional parents/guardians income/assets: ______+______
______
Please list other significant assets ( > $1000 value ie: Car) ______
______
Other sources of income: Gifts / Investments / Savings / Etc.______
______
Personal references:
1.______
2.______
3.______
Community Service
On a separate document, please outline your personal contributions to your community in the past four years. Be sure to give names/ locations of service, dates, hours, descriptions of service/volunteer duties and name of a contact person. (Examples of community service- boy scouts, girl guides, 4H, candy striper, other hospital volunteer, service clubs, YMCA, red cross, senior citizens, church work, recreation, coaching, etc.
As well, please provide a commentary explaining why the Rotary Club of Barrie-Huronia should consider your application.
Declaration
I, ______, hereby apply for a bursary award under the terms of
(name of applicant)
the Rotary Club Community Service Award, and I hereby declare that all information given is complete and accurate and that I will be a full-time student for the academic period stated, and that the financial aid is essential to enable me to continue my post-secondary education, and that if I am approved as a recipient, I will use the proceeds of my award for payment only of educational and living costs directly related to my course of study.
Signature of applicant: ______Date:______
Submit application by one of following methods to:
Vocational Services Committee Director:
Email:
Fax: 705-727-9930
Mail :Rotary Club of Barrie-Huronia
PO Box 157,Barrie, Ontario
L4M 4T2
All submissions are confidential to the selection committee of the Rotary Club of Barrie- Huronia. If more information is relevant to any section of this application than space permits, please submit additional documents or pages as required. Any decisions with regards to awards are at the sole discretion of the Rotary Club of Barrie-Huronia.