Senator Patrick Burns Legacy Scholarship Application

Deadline for Submitting Applications:February 28

(ONLY SUCCESSFUL CANDIDATES WILL BE CONTACTED)

1. Student’s Personal Information:

student’s full name / EMAIL ADDRESS
MAILING Address (Must be a resident of calgary)
city, province / Postal Code / phone number
Date of birth / social insurance number

2. Student’s Education Information:

name of last attended high school
year / expected graduation date (if applicable)
grade or level of education attained

3. Post-Secondary Information:

name of institution
year / course and faculty
address
city, PROVINCE/STATE / postal code/zip code / country
Have you been accepted?
if not, why?

HAVE YOU APPLIED FOR, OR BEEN AWARDED, ANY OTHER SCHOLARSHIPS OR BURSARIES FOR THE UPCOMING ACADEMIC YEAR? IF YES, PROVIDE DETAILS:

HAVE YOU PREVIOUSLY RECEIVED A SCHOLARSHIP/BURSARY FROM THE BURNS FUND?
IF YES, IN WHAT YEARS?

Please note: applicants may apply for both the Senator Patrick Burns Legacy Scholarship and the WLC Inspiring Futures Scholarship. However, successful candidates will be eligible to receive only one of these two scholarships.

Other Required Documents:

  1. Write a letter outlining your post-secondary education plans, your proposed area of study, length of program, and how you plan to fund this education. Also include comments on any extracurricular and/or volunteer involvement, as well as the financial circumstances which require you to apply for a scholarship.
  2. Ask your counsellor for a print-out of your grade 10 - 12 credits (completed and pending).
  3. If living at home, please include a copy of your parent’s (both if applicable) most recent income tax “Notice of Assessment.”
  4. If living independently, please supply documents showing your monthly income (paystubs, etc.)
  5. Ensure that your high school counsellor completes a “Counsellor Referral Form.”
  6. Reminder: students must be residents of Calgary to be eligible for this scholarship.

Signature of student / Date

Burns Memorial Fund follows legislated guidelines for privacy. By signing this page, you give expressed consentto be contacted via email by the Burns Memorial Fund.If you do not wish to give your expressed consent for email correspondence, please let us know at .

Please submit this application form and all other required documents (via mail, email or fax) to:

Burns Memorial Fund

Kahanoff Centre

1120, 105 12th Avenue SE

Calgary, AB T2G 1A1

Phone: (403) 234-9396 ext. 2 | Fax: (403) 233-0513 | Email: |

Counsellor Referral Form

student’S Name

Why are you RECOMMENDING the student for the senator patrick burns legacy Scholarship?

Note: Should you require more space, please attach no longer than one separate page. Applicants may also apply for both the Senator Patrick Burns Legacy Scholarship and the WLC Inspiring Futures Scholarship. However, successful candidates will be eligible to receive only one of these two scholarships.

School Counsellor’s Name / Phone number
School / Email Address
Signature / date

BURNS MEMORIAL FUND FOLLOWS LEGISLATED GUIDELINES FOR PRIVACY.

Please submit this referral form as part of the scholarship application (via mail, email or fax) to:
Burns Memorial Fund
Kahanoff Centre

1120, 105 12th Avenue SE

Calgary, AB T2G 1A1

Phone: (403) 234-9396 ext. 2 | Fax: (403) 233-0513 | Email: |

Deadline for Submitting Applications: February 28

Partially funded by the Integro Legacy FundPAGE 1 OF 3