Bishop Allen Academy

BISHOP ALLEN ACADEMY

SCHOLARSHIP APPLICATION PACKAGE

Name: / Student Number:
E-mail Address: / Volunteer Hours Completed: Yes No
How many total to date: ______
Ethnic Origin: / Physical Disability/ Handicap: Yes No
If Yes, please describe.
Does your family qualify as low or middle income? (see bottom of page 3)
Low Middle / Describe any hardships or difficulties (chronic illness or deaths in family, need to work to contribute to family’s expenses, etc) that may have affected your academic achievement to date.

Academic Excellence:

Grade 11 Average: ______

Briefly outline career goals:

I am planning to apply to the following universities or colleges (rank in order of preference):

UNIVERSITY / PROGRAM

RELEASE OF INFORMATION: I permit all information on these sheets to be used within the school by staff involved with scholarship applications.

______

SIGNATURE

For Office Use Only- Date Submitted: ______

Scholarship Application Package Page 1 of 5 Updated: Sept 2016

A. AWARD OF DISTINCTION (i.e. MVP/MIP, Team Captain, Honour Roll, Subject Award etc.)

AWARD/ DISTINCTION / YEAR (S)

B. EXTRACURRICULAR PARTICIPATION (NON-LEADERSHIP)

CLUB/ GROUP/TEAM / YEAR (S) / NUMBER OF HOURS / MODERATOR’S
NAME

Scholarship Application Package Page 2 of 5 Updated: Sept 2016

COMMUNITY INVOLVEMENT / YEARS (S) / NUMBER OF HOURS / MODERATOR’S
NAME

The Government of Canada’s Canada Student Grants program defines “financial need” according to the following thresholds:

SIZE OF FAMILY / LOW INCOME / MIDDLE INCOME
1 person / $24,747 / $44,751
2 persons / $30,811 / $62,652
3 persons / $37,878 / $77,779
4 persons / $45,987 / $88,515
5 persons / $52,159 / $96,846
6 persons / $58,827 / $103,643
7 or more persons / $65,495 / $109,401

Scholarship Application Package Page 3 of 5 Updated: Sept 2016

C. STUDENT LEADERSHIP (SCHOOL OR COMMUNITY)

CLUB/ GROUP/ TEAM / LEADERSHIP
ROLE / YEAR (S) / NUMBER OF HOURS / MODERATOR’S
NAME

D. WORK EXPERIENCE

Name of Employer / Duties / Hours (Weekly) / Supervisor’s Name

E. Other awards, distinctions, experiences, or merits not covered by the above that you want to bring to the attention of the Scholarship Committee.

Scholarship Application Package Page 4 of 5 Updated: Sept 2016

E. Prepare and attach a one page response (printed or keyed) to one of the following:

Describe your most significant achievement to date and why you feel it is so OR describe a difficult leadership situation you faced and how you overcame it.

F. Please sign below your agreement and a parent/ guardian agreement for Bishop Allen Academy to acknowledge, publicly, your success in attaining a scholarship in a suitable manner (i.e. P.A. announcement, website announcement, notice board, newsletter, local newspaper, etc.)

Student Signature: ______

Parent/Guardian Signature: ______

Date: ______

Scholarship Application Package Page 5 of 5 Updated: Sept 2016