2015 General Application Form

2015 General Application Form
Faculty of Arts Administered Awards
This is a general application form for selected bursaries and scholarships administered by the Faculty of Arts. These
awards are unique to our Faculty and have been endowed especially for Arts students. They are meant to support and
encourage talented students who encounter financial difficulties.
Current and prospective Arts students are welcome to apply for any of the awards for which they qualify (see B.). The
deadline for application is 3:00 pm, Friday, September 18, 2015. Applications received past this deadline will not
be considered.
Keep in mind that this is not an application for any of the undergraduate awards administered by the Office of
Student Awards. A full listing of those and other awards and a description of the application process can be found at
 1. Read the award descriptions online to determine those for which you may qualify (see instructions below);
 2. Indicate your interest in the appropriate award(s) using the check boxes;
 3. Fill out all pages of this application in full. (Failure to complete any of sections A through E will result
in your application not being considered).
A. Personal / Academic Information
Student ID#:____________________
Name: Mr Ms Mrs
First Name
Citizenship: Canadian
Telephone: (
Postal Code
Parent/Guardian Address (if applicable):
Middle Initial
Telephone : (
Postal Code
Permanent Resident
Student Visitor - Citizen of
Number of years you have lived in Alberta:
Number of years you have lived in Canada:
Arts Degree: BA Major(s):
 BA Honors Major(s):
 BFA  BDes  BMus  BMus/BEd  BA Crim  BA Environmental Studies  BA (Drama)/BEd
Year of Program completed as of the end of April 2015:
(As of Sept. 2015)
1(0-30) 2 (31-60) 3 (61-90) 4 (91-120)
B. Statement of Interest
Review the descriptions and criteria for these awards on the Office of the Registrar, Scholarships and Awards site for
details to determine if you are eligible to apply. **High school and *Transfer students may apply ONLY for the awards
I wish to apply for: (Check the appropriate box(es).)
 The Patricia Clements Scholarship in Arts
 The Edmonton Journal/
$1500; one awarded
Dean of Arts Award of Distinction*
(Minimum GPA 3.5 (on at least24), entering Year 2)
 Dr. Isabel (Landels) Wilkins Memorial
$500; one awarded
(Dean’s Honors List, minimum30 remaining in program)
 John &Hilda Rebus Memorial Scholarship
$500; one awarded
(Dean’s Honors List, minimum 30 remaining in program)
 The Johanna Houwen Memorial Award
$4500, payable over three years; one awarded
(Canadian Citizen or Permanent Resident, minimum GPA3.3,
entering Year 2, registered full-time—at least 24)
$4500, payable over three years; one awarded
(Minimum GPA 3.3, majoring in Humanities or Social Sciences,
entering Year 2 of program)
 IF Grape Memorial Scholarship
$500; one awarded
(Superior Academic Achievement, majoring in Modern
Languages & Cultural Studies—entering Year 4)
 Scotiabank Bursary**,*
$1500; four awarded
(Minimum 9 per term, HS minimum 80%, postsecondary
minimum GPA 3.0)
C. Applicant Information (If you require more space, please attach a one-page typed letter)
Please indicate any other special circumstances regarding your financial need. (This information is required since all of
these awards are based on both financial need and academic performance).
2. List any extracurricular and volunteer activities in which you have participated during the last year.
3. Specific vocational goals after graduation including any special field of interest or type of employment planned.
D. Financial Information (Please complete your calculations based on the 8-month period from September 2015 to April 2016)
Have/Will you apply for a student loan in 2015/2016? Yes No
If yes, how much was requested $
What is your total indebtedness to the Students’ Finance Board or other agency as of April 30, 2015?
Expenses (for 8 months)
Rent & Utilities
Food & Personal Care
Part-time earnings during school term (8 months)
Contribution from parents/spouse
Investments (please specify)
Child Care
Other income (tax rebate, family allowance)
Tuition, Fees, and Books
Scholarships/Bursaries confirmed for 2015/16
Other Expenses (please specify)
Other Resources:
Total Expenses (for 8 months)
Total Resources (for 8 months)
(do not include student loan if listed above)
Amount Required
Total Expenses
Total Resources
Total Required
E. Signature
This Application must be signed.
I CERTIFY that the information contained in this application is complete and correct. I authorize the Selection Committee to access my
academic transcripts and contact my referees if necessary. I further authorize the Student Awards Office, if necessary, to report my name,
address, program and award status to the donor(s) of this award and to use my name in various public relations publications, presentations, and
announcements to promote the University’s awards programs.
The personal information requested on this form is collected under the authority of the University Act and Section 33(c) of the Alberta Freedom
of Information and Protection of Privacy Act to determine your eligibility for scholarships and awards. Certain personal information may be
made available to federal and provincial departments and agencies under appropriate legislative authority. Personal information is protected
under the Alberta Freedom of Information and Protection of Privacy Act. For further information, contact the Office of the Dean, Faculty of
Arts, 6-33 Humanities Centre, University of Alberta, Edmonton, AB T6G 2E9; phone (780) 492-2787.
Forward applications to Undergraduate Student Services, Faculty of Arts, 1-17 Humanities Centre, University of Alberta, Edmonton, AB,
T6G 2E5. Applications must be received by 3:00 pm on Friday September 18, 2015.
H:\Common\Scholarships and Awards\Fac Adm (Green form)\2015\2015General Awards Application Form (legal).doc