The 2015 AEBC And
T-Base Communications
Scholarship Application
To assist users who are blind, a caret indicator (^) has been provided next to each question in the application form. Please type your response after the caret (^).
Completed applications, along with supporting documents, should be e-mailed to no later than Friday, June 26th, 2015.
Part A: Your Information
First name: ^
Last name: ^
Mailing address (line 1, e.g. 1 Rodney Lane): ^
Mailing address (line 2, e.g. Apt. 224): ^
City: ^
Province: ^
Postal code: ^
Home telephone number: ^
Cellular/mobile telephone number: ^
Email address: ^
Your status in Canada (write ‘yes’ next to the appropriate choice):
(a) I am a Canadian citizen: ^
(b) I am a permanent resident: ^
(c) I am a foreign student studying at a Canadian institution: ^
Part B: Your Educational History
If you are not currently in school, please skip down to Part C, below.
Are you presently in school – yes or no? ^
If you are not in school, when did you last attend (year)? ^
If you are not in school, answer the following four questions based on your most recent educational experience.
The name of the educational institution I attend (or attended) is: ^
This institution is (or was) located in (city & province): ^
This institution is (or was) a … (High school? College? University? Describe it.): ^
Part C: Your Educational Plans for 2015-2016
Name of the institution: ^
This institution is located in (city & province): ^
This institution is a … (High school? College? University? Describe it.): ^
Program name (e.g. B.A. with a Major in English): ^
Will you be studying part-time (i.e. taking 2 courses per semester) -- yes or no? ^
Will you be studying full-time (i.e. taking 4 or more courses per semester) -- yes or no? ^
My career goal is to become a …: ^
Part D: Additional Information
How did you hear about this scholarship program? ^
By submitting your application, you are certifying that the information you have provided is correct and true to the best of your knowledge, that you (as the applicant) are blind, deaf-blind or partially sighted, and that you meet all other eligibility criteria for the AEBC and T-Base Communications scholarship program. Additionally, if you are selected as a scholarship winner, you agree to have your name and other content related to the award featured in online properties such as AEBC and T-Base social media communities, websites, and possible participation in interview-style blog postings at the time of the award and throughout the 2015/2016 scholarship year.
Please indicate, by typing your first and last name, that you have read, understand, and agree with the above statement: ^
Date (day, month, year): ^
Please note: The Alliance for Equality of Blind Canadians (AEBC) is committed to protecting the privacy, confidentiality, accuracy, and security of any personal information that we collect, use, retain, and disclose in the course of the programs we offer. If you have any questions about protecting your personal privacy or our privacy policy, contact our Compliance Officer by calling (1-800-561-4774 or by e-mail at: .
WAIT ONE MOMENT. Have you confirmed that each of the documents (required to complete your application) will be included with your submission e-mail? Those documents include: (a) This application form; (b) Your transcript; (c) Your personal statement (maximum 500 words); (d) Your essay on ‘accessible education’ (maximum 500 words); and (e) Your letter of reference?
If all of this is in order, e-mail all of these documents to . We will do our best to acknowledge receipt within 48 hours. If you do not receive an acknowledgment of receipt, please e-mail or telephone us at 1-800-561-4774 to inquire as this may mean that your application did not arrive.
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