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Boys and Girls Clubs of Canada 2017
Scholarship Application Form
TIP: You can jump between pages of the application form by clicking the "Go to:" links above. NOTE:
APPLICANT MUST BE ENROLLED IN FULL-TIME OR PART-TIME STUDIES AT AN ACCREDITED POSTSECONDARY INSTITUTION BEGINNING SEPTEMBER 2017 OR THE SCHOLARSHIP WILL BE REASSIGNED.
General Applicant Information
Unless otherwise indicated by an asterisk (*), all questions must be
answered.
Please tell us your name and provide us with some other important
information:
First name:
*Middle initial:
Last name:
Gender:
Male
Female
Other
*Apt. #:
Street address:
City:
Province/Territory:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal code (format: A1A 1A1):
Phone number (format: 123-456-7890):
*Cell phone number (format: 123-456-7890):
Social Insurance Number:
Email:
*Student number:
Date of birth:
____/__/__ (YYYY/MM/DD)
What is your current post-secondary status?
I have applied to post-secondary
I am currently enrolled in post-secondary
Post-secondary program information:
Please tell us about the program you have applied to:
Name of program:
School name:
City:
Province/Territory:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Not Applicable
Post-secondary program information:
Please tell us about the program you are enrolled in:
Name of program:
School name:
City:
Province/Territory:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Not Applicable
Have you received a scholarship from BGCC in the past?
Yes
No
What years did you receive a BGCC scholarship?
2013
2012
2011
2010
2009
2014
2015
2016
Which scholarship(s) have you received?
BGCC Post-secondary scholarship
BGCC Central Region (Ontario) scholarship
Future Generation/Best Buy (Grade 10) scholarship
Are you related to a current Boys and Girls Club employee or board
member ?
*Related means you are the son/daughter, brother/sister, niece/nephew, grandchild, step- or half-child,
or any child living in the same premises as an adult who has legal guardianship.
Yes
No
Please tell us the name of the Boys and Girls Club employee or board
member you are related to:
Name:
Position:
Relationship:
Club Participation Information
Club Information:
What Club are you affiliated with?
Airdrie
Albion
Bashaw & Area
Battlefords
Bonnyville
Botwood
Braeburn
Brantford
Calgary
Camrose
... 78 additional choices hidden ...
Winnipeg
Wolf Creek
Yarmouth
York Region
Yorkton
Yukon
Foothills
Sherbrooke
Greater Halifax
Trois-Rivères
City:
Province/Territory:
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
How many years have you been involved with the Boys and Girls Club?
Applicant must be a current or former Club member for a minimum of one year.
Years as a member/participant:
Years as a volunteer:
Years as staff:
What Club programs and/or activities have you been involved with?
How many other volunteer/community service organizations are you
involved with?
None
One
Two
Three
Four
Other volunteer/community service activity #1
Name of volunteer/community service organization:
Number of years of service:
Describe your involvement:
Other volunteer/community service activity #2
Name of volunteer/community service organization:
Number of years of service:
Describe your involvement:
Other volunteer/community service activity #3
Name of volunteer/community service organization:
Number of years of service:
Describe your involvement:
Other volunteer/community service activity #4
Name of volunteer/community service organization:
Number of years of service:
Describe your involvement:
Budget
*Note: The totals for each section will be automatically calculated. **WHEN ENTERING NUMBERS INTO
YOUR BUDGET, DO NOT USE ANY PUNCTUATION MARKS OR SPACES. FOR EXAMPLE, TYPE "1200" NOT
"1,200.00" OR “1,200” OR "1 200".
INCOME FOR THE SCHOOL YEAR
Amount:
Personal savings:
Employment income:
Family contributions:
Scholarships/bursaries:
Other income for school year:
Amount:
Other:
Other:
Other:
Other:
Please specify source:
Total Anticipated Income:
EXPENSES FOR THE SCHOOL YEAR
School-related expenses (for one year):
Amount:
Please specify expense:
Tuition and fees:
Books and supplies:
Travel (relocation costs only):
Living-related expenses (for September 2017 – June 2018):
Amount:
Please specify expense:
Accommodation (rent, phone, cable, utilities, etc.):
Transportation (car, transit):
Food (during school year):
Other personal expenses (for September 2017 – June 2018):
Amount:
Prior financial obligations (e.g. student loans):
Child care:
Other expenses (for September 2017 – June 2018):
Amount:
Other:
Please specify expense:
Other:
Other:
Other:
Total expenses:
*Note: This total will be calculated automatically. Please do not type into or edit the field below.
Total (INCOME - EXPENSES):
*Note: This total will be calculated automatically. Please do not type into or edit the field below.
ONTARIO RESIDENTS ONLY: To your knowledge, are you eligible to
receive a free tuition grant from OSAP? If you are unsure you can use this
tool to check: https://www.ontario.ca/page/osap-ontario-studentassistance-program
* Please note that answering yes to this question does not affect your eligibility for a BGCC postsecondary scholarship
Yes
No
ONTARIO RESIDENTS ONLY: Are you planning to apply to Ontario
Student Assistance Program (OSAP) for the 2017-2018 school year?
* Please note that answering yes to this question does not affect your eligibility for a BGCC postsecondary scholarship
Yes
No
Letter of Intent
Please tell us about your career and educational goals for the future and
how a Boys and Girls Clubs of Canada scholarship will help you meet or
overcome any existing barriers to your success.
150 word minimum. 500 word maximum.
Legal Release
I Declare the following:
I have read, understood and comply with the criteria related to this application. I have honestly and
accurately completed all aspects of this application. I understand that all submissions, including all
intellectual property rights, become property of Boys and Girls Clubs of Canada. I understand that Boys
and Girls Clubs of Canada reserves the right to use all such material they receive . I consent to the use of
my name and/or photo in any form of media in conjunction with Boys and Girls Clubs of Canada
Scholarships. I understand that personal information such as my Social Insurance Number (SIN) is
required by the Canada Revenue Agency (CRA) for the purpose of issuing T4A Slips. Personal information
of this nature will not be shared, traded, sold or used in any manner not explicitly approved by you. If
you have any questions or concerns regarding Boys and Girls Clubs of Canada and your privacy,
please contact our Privacy Officer at [email protected]. Should my financial situation change
significantly, (i.e. notification of additional scholarships, etc.) after the submission of my application, I
will notify the Boys and Girls Clubs of Canada for discussion.
By clicking the box below, I warrant that I have read and understood the
declaration and release above.
Applicant name:
Please type your name into the box below.
Date:
____/__/__ (YYYY/MM/DD)
How would you like to submit your recommendation letter(s)?
Part of your application requires you to provide at least one letter of recommendation. The maximum
number of recommendation letters you can provide is two. Recommendation letters can be completed
by a teacher, employer, coach, Club staff member, etc. Your first letter of recommendation must come
from someone other than a family member and cannot come from another applicant. It should also be
from someone other than the person completing our Club Staff Nomination Form. Your second letter of
recommendation may come from a family member, teacher, employer, coach, Club staff member, etc.
Upload it: Print the recommendation criteria, ask for a recommendation letter, upload it
Request by email: Send an email to your recommender requesting that your recommendation be
completed online
The "Upload it" and "Request by email" tasks will show in your task list
after you've clicked "Save & Exit".