______
Student Scholarship Application Form
For Leadership for Life Course
The information collected on this form will be protected under the
Municipal Freedom of Information and Protection of Privacy Act.
Student Information:PLEASE PRINT CLEARLY
Legal Name: ______
SurnameFirst NameMiddle Name
Preferred Name: ______
(If different from Legal Name) SurnameFirst NameMiddle Name
Male □ Female □ Date of Birth: ______
YYYY/ Month/DD
Toronto Address: ______
Street No. and Name Apt. # City Postal Code
Mailing Address: ______
(If different from above)Street No. and Name Apt. # City Country Postal Code
Home Country Address: ______
(If applicable) Street No. and Name Apt. # City Country Postal Code
Toronto Home Phone No: ______Cell Phone No:______
Area Code – Phone Number Area Code – Phone Number
E-Mail Address: ______
Current School Information:
Current or Last School Attending: ______
Last Date Attended (If applicable): ______
YYYY/ Month/ DD
Ontario Education Number (For current Ontario Student ONLY): ______
School Address: ______
Street No. and Name City Country Postal Code
School Phone Number:______School Fax Number: ______
Scholarship Submission:
I wish to apply for a Trinity/Laureate Scholarship for ______(Course Code)I meet the following requirements for this scholarship:
_____ a full-time/part-time student at a secondary level
_____ a one-page essay on why you should be selected for the scholarship (to be attached)
Contact Information:
Primary Reference
Name: ______
Mr/Mrs/Ms Surname First Name Middle Name
Relationship to Student:Teacher/Principal/Educator□ Other □______
Home Phone Number: ______Business Phone Number: ______
Area Code – Phone Number Area Code - Phone Number
Cellular Phone Number:______E– Mail Address: ______
Area Code – Phone Number
Secondary Reference
Name: ______
Mr/Mrs/Ms Surname First Name Middle Name
Relationship to Student: Teacher/Principal/Educator□ Other □ ______
Home Phone Number:______Business Phone Number: ______
Area Code – Phone Number Area Code - Phone Number
Cellular Phone Number: ______E– Mail Address: ______
Area Code – Phone Number
SCHOLARSHIP POLICY:
The scholarship is applied directly to the tuition fee of the course and will be denied if:
- Student withdraws for any reason.
- Student has violated any school regulations and asked to withdraw from school.
I have read, understand, agree, and accept to follow the rules and guidelines as outlined above. Further, I consent to the receipt of all e-mail communications from Trinity TheatreLaureate International College (LIC) in regards to school and student information and reminders.
______Date: ______
Signature of Student YYYY/ Month/ DD
______Date: ______
Signature of Parent(if student is under 18 years of age) YYYY/ Month/ DD
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