QUEEN ELIZABETH II DIAMOND JUBILEE
Canadian Scholars & Interns
AWARD APPLICATION - 2016 / 2017
Choose the appropriate Eligibility Declaration below (Component #1 or #2):
Section 1: Eligibility Declaration - Scholarships for Canadian Students to Commonwealth Countries
Component 1: Scholarships for Canadian Students to Commonwealth Countries
This component will award scholarships to graduate students enrolled at the University of Alberta to complete a semester or a year abroad
outside of Canada at a partner Commonwealth university or to conduct research in a Commonwealth country.
To accept QES Scholarship for Study Abroad, I acknowledge that (all boxes must be checked):
□ I am a Canadian citizen or Permanent Resident.
□
□
□
□
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I am enrolled in at University of Alberta at time of application.
I am enrolled in a graduate program (FRM, ALES, SPH, FNS, FN).
I am 35 years of age or under at time of application
I will participate in community engagement activities in Canada upon return.
I will submit a Final Evaluation upon completion.
Section 1: Eligibility Declaration - Internships for Canadian students to Commonwealth Countries
Component 2: Internships for Canadian students to Commonwealth Countries
The program will enable senior-level University of Alberta students to participate in internships for a minimum of three months with partner
organizations in Commonwealth countries.
To accept QES Scholarship Internship, I acknowledge that (all boxes must be checked):
□ I am a Canadian citizen or Permanent Resident.
□ I am enrolled in at University of Alberta at time of application.
□ I am entering or enrolled in my third or fourth-year of undergraduate level studies / graduate program, in one of the following faculties:
FRM, ALES, SPH, FNS, FN.
□ This internship will be for academic credit.
□ I am 35 years of age or under at time of application.
□ I will participate in community engagement activities in Canada upon return.
□ I will submit a Final Evaluation upon completion.
Section 2: Applicant Information
First Name:
Last Name:
UAlberta ID Number:
UAlberta Email:
Home Phone:
Cell Phone:
Faculty/Department:
Undergraduate
Graduate
Major (if applicable):

Year of
Program
Degree Program :
Minor (if applicable):
QES Scholarship Application (2016 / 2017 Competition) ◆ 1
Section 3: Study Abroad or Internship Information
You may attach a brief syllabus or outline of the abroad opportunity, if available.
Name & Description
of Study Abroad / Internship Program
UAlberta Faculty Contact
(Name, position, email, phone number)
Destination of Study / Internship
(City, Country; Host Institution /
Organization, Host Institution /
Organization Supervisor)
Type of Program
Study Abroad
(Choose one)
Start Date
of Program Abroad:
Internship
End Date
of Program Abroad:
I Confirm that I will receive Credit for
my participation in QES
Yes
No
Total Duration
Abroad (in weeks):
Course Name & # of Credits
Section 4: Previous International Experience
Countries Lived in:
Countries Visited:
Section 5: Budget
Fill in the budget below as a proposed statement of the estimated costs of your Study Abroad / Internship experience.
You do not need exact numbers but estimated figures to help you be aware of the costs of going on exchange.
NOTE: QES funding (CAD $6000) is allocated for Living Expenses by the funder
Revenue Source (please identify source & allocate to appropriate expense)
Expense
Total Cost
QES
Faculty Grant /
Other Funding
Faculty
TA / RA
UAI Individual
Award
Partner
Organization
Other
(self / other)
Academic
(tuition, supplies,
research and conference
expenses)
Living
(food, accommodation,
installation allowance
and health insurance)
$6000
Travel
(return airfare and visa)
Total (in CAD)
QES Scholarship Application (2016 / 2017 Competition) ◆ 2
Section 6: Community Engagement Plan
Using only the space provided, outline your Community Engagement Plan.
Below are outlined some of the basic expectations of QE II Scholars (which you can include in your Community Engagement Plan):
1.
Faculty specific conferences, talks, presentations;
2.
QES Scholarship recipients will be asked to be available for mentorship to other / future QES recipients;
3.
You will be invited to submit a proposal for presentation during International Week.
In addition to the above, QE II Scholarship recipients are encouraged to consider other ideas. For example:
1.
Are you currently engaged in community organizations here in Edmonton?
2.
Are you part of a student club (SIHA for example)?
3.
Are you conducting any research through your studies that is Canada focused?
4.
Do you have an idea on how to link your international experience to needs in Canada?
Section 7: Supporting Documents
You must submit the following supporting documents along with your application electronically.
1.
Unofficial Transcripts: Unofficial transcripts of ALL completed postsecondary coursework at the University of Alberta.
Submit transcripts as scanned PDFs via email. Jpegs will not be accepted.
UAlberta Transcripts
Unofficial transcripts can be printed from Beartracks—you may need to wait for Winter Term grades to be posted for your most recent term. Do not
submit official transcripts or statements of results.
2.
Letter (or Email) of Support from Faculty
3.
Letter (or Email) of Admission / Support from International Host Institution / Organization
4.
Letter of Support from Canadian Community Engagement Host (if applicable)
5.
QES Scholar PreDeparture Form - Canadian 2016
Section 8: Declaration and Signature
I certify that the information submitted on my Queen Elizabeth II Diamond Jubilee Scholarship application form is complete and accurate, and I authorize the
collection of this information for the purpose of administering the Queen Elizabeth II Diamond Jubilee Scholarship.
I further understand that information on the form is collected under the authority of Section 33(c) of Alberta’s Freedom of Information and Protection of Privacy
Act for authorized purposes including admission and registration; administration of records, scholarships and awards, student services; and university planning
and research.
Personal information may be disclosed to academic and administrative units according to university policy, federal and provincial reporting requirements, data
sharing agreements with student governance associations, and to contracted or public health care providers as required. For details on the use and disclosure
contact University of Alberta International at 780-492-3600 or see www.ualberta.ca/FOIPP.
Signature:
Printed Name:
Date:
QES Scholarship Application (2016 / 2017 Competition) ◆ 3