Alouettes Bursary Program

2016 bursary application form

Secondary and college levels

Family name: ______First name(s): ______
You must complete a form for each category in which you are applying.
Check the applicable bursary category :
Secondary level:
Athletic Excellence for 11thgrade graduates / Academic Excellence for 11th grade graduates
Athletic Excellence for 10th grade graduates / Academic Excellence for 10th grade graduates
Perseverance for 11thgrade graduates / Leadership for 10th or 11th grade graduates
Perseverance for 10th gradegraduates
College level:
Athletic Excellence / Leadership
Academic Excellence
Procedure
1.Read the eligibility and selection criteria.
2.Fill out the bursary application form, providing maximum information, all-star selections, statistics, etc. For the leadership or perseverance category, the last 2 pages of this form must be completed.
3.For secondary students, provide grades for the third semester of Grade 10 or 11 by June 11, 2016. For college level students,send complete transcript of 2015-2016.
4.Sendby email a well identified high resolution (at least 600 KO) action shot where the player is clearly visible.
5.For RSEQ LEAGUES, return the form by June 10, 2016 to Mrs Diane Perron by e-mail (preferably) at by regular mail to her attention at:
Réseau du sport étudiant du Québec
4545, ave. Pierre-de Coubertin, Montréal (Québec) H1V 0B2
6.For Football Québec civil leagues, return the form by June 10, 2016by e-mail (preferably) at or by regular post to:
Football Québec

4545, ave. Pierre-de Coubertin, Montréal (Québec) H1V 0B2

7.The deadline for candidate submissions is Friday,June 10, 2016.

To receive confirmation of receipt of your application form, please include your e-mail address: ______

Program administered by the Quebec Foundation for Athletic Excellence and Football Québec, in collaboration with the Réseau du sport étudiant du Québec (RSEQ).

PERSONAL INFORMATION

Family name:______First name(s): ______

ADDRESSADDRESS OF PARENTS (if different)

______

(Number, street, apt.)(Number, street, apt.)

______

(City, province)(City, province)

______(_____)______(____)______

(Postal code) (Telephone)(Postal code) (Telephone)

(____)______

(Cellular phone number) (Social insurance number)

______

(Date of birth day/month/year)(E-mail)

SPORTS INFORMATION

YEAR / TEAM OR CLUB (Jersey Number and Position) / COACH
2013-2014
2014-2015
2015-2016
2016-2017

Have you already been part of the excellence programs of Football Québec, Challenge Wilson, or the MU15, MU17 or MU20 programs, Team Canada?

If yes, indicate which program and when______

______

INDIVIDUAL STATISTICS

Provide individual statistics for position(s) played: pass completion percentage, yards gained, touchdowns, points, field goals, success percentage, average yards per field goal, average yards per punt, punt returns, kickoff returns, passes caught (percentage and average yards), tackles, sacks, special teams tackles, interceptions, fumble recoveries, etc.

______

______

______

______

______

______

______

SPORTS AWARDS

All-star selections, offensive or defensive player of the year, team player of the year, school athlete of the year, student-athlete, etc.

MONTH/YEAR / NATURE OF AWARD

Athletic objectives 2016-2017

______

______

______

______

______

ACADEMIC INFORMATION

YEAR / INSTITUTION / MAJOR / DIPLOMA
2013-2014
2014-2015
2015-2016
2016-2017

Will you be a full-time student in September, 2016?Yes No

Have you received academic honours or distinctions?

YesNo

Month/Year / NATURE OF AWARD

N.B.: Please include a copy of your secondary or college academic grades – MANDATORY

RESERVED FOR PERSEVERANCE BURSARY APPLICANTS

Explain why you are a good candidate to receive a perseverance bursary this year. What methods did you use to achieve your goals?

RESERVED FOR LEADERSHIP BURSARY APPLICANTS

Describe the deeds or ongoing activities in which you have participated to change or improve conditions in your community. Also, describe the roles and responsibilities that demonstrate your leadership abilities, particularly your capacity for motivating and leading others.

Indicate the duration and extent of your involvement. You may include personal references or documents in support of your application.

Formulaire révisé le 13 avril 2016.