Ralph Akiwenzie Scholarship Application Form
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3Ralph Akiwenzie Scholarship Application
Please refer to Scholarship Terms of Reference and Guidelines
Section 1.0 Personal Information
Surname
Given Name
Telephone
Email
(
)
Mailing Address
City/Town
Province
Postal Code
Other Phone
Gender
□
Male
□
Female
□
□ Band # ________________
Member of Chippewas of Nawash
Yes
□
Attach a copy of your status card, both sides
Section 2.0 Academic Information
Education Level Achieved to Date:
Last School Attended
Graduation year:
Name of the Diploma/Degree you are pursuing:
Full-time studies
Part-time studies
□
Please attach a copy of your latest school transcript.
Transcript Attached:
Section 2.1. Academic Intentions
Please list post-secondary institutions to which you have applied or intend to apply. Please provide a letter of
acceptance if you have been admitted to the post-secondary institution.
1.
2.
3.
Section 3.0 Financial Information
Have you applied for other financial assistance (bursaries, student loans, scholarships, etc)
□
□ No
Yes
If yes, for which ones and for what amounts (please be specific)? If you will be receiving any other financial assistance,
please specify the source of assistance, in what form and in what amount, eg. “funding from the Nawash Post
Secondary Assistance Program; for tuition, books in the amount of $xxxx.xx”
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