Ralph Akiwenzie Scholarship Application Form (Page 2 of 3) in pdf

Please outline your estimated expenses for the next school year.

Tuition $_________________________________

Food $___________________________

Books/supplies$___________________________

Rent/Residence$____________________

Other(Specify)$ ___________________________

TOTAL EXPENSES $________________________

AMOUNT OF FUNDING YOU ARE REQUESTING $____________________________________

What total contribution do you plan to make towards your education expenses for the next school year?

$__________________________

□ No

Are you currently employed

□ Part-time

□ Full-Time

How do you plan to contribute to the costs of you post secondary education?

□ Yes

□ No

Do you plan to work while attending school?

Section 4.0 Achievements, Aspirations and Personal Supports – One page Essay Attachment

On a separate page, describe any personal achievements you think we should know about, aspirations in the near and

distant future (how you plan to get there) and you r personal supports; people in your life who have given you support

and would be willing to continue with this kind of support . Describe how you see your support team working for you.

Include as much information that you think we should know about while assessing your application. Keep to a

maximum of one page, (type written). Applications received without this one page essay attachment will not be

considered. NOTE: We can only know you thorough the information you give us. Please be thorough and complete.

□ Yes

□ No

One page essay attached and complete.

Section 5.0 Additional Information

How did you hear about the Ralph Akiwenzie Scholarship?

Section 6.0 Personal References

Please attach the following:

□ Personal Reference – One letter of support completed and attached. This letter can come from a teacher,

employer, friend or a family member

When submitting the application form, please be sure to clearly label and attach the following:

□ Section 2.0 Academic Information Transcript

□ Section 2.1. Academic Intentions

□ Section 4.0

One page Essay Attachment

□ Section 6.0 Personal Reference

□ Completed application form

DECLARATION: I certify the information provided by me to be true and agree to abide by the terms of reference of

the scholarship if this application is approved.

Signature: _____________________________________

Ralph Akiwenzie Scholarship Application Form Page 2