APPLICATION FORM

                                                     

 

 

                                                             ALBERTA BEACH & DISTRICT AGRICULTURAL SOCIETY

                                                     SCHOALRSHIP FUND APPLICAITON FORM

 

 

 

 

 

NAME: __________________________________________________________________________________ 

 

MAILING ADDRESS: ___________________________________    DATE OF BIRTH: ____________________

 

                             ___________________________________

             

                             ___________________________________

 

                             POSTAL CODE: ______________________

 

EMAIL ADDRES: ______________________________________________________

 

PHONE NUMBER (S): __________________________________________________

 

NAME OF INSTITUTION GRADUATED FROM: _______________________________________________

 

YEAR OF GRADUATION: ______    

 

ADDRESS OF INSTITUTION: ________________________________

 

                                         ________________________________

 

                                         ________________________________

                                 

                                        POSTAL CODE: ____________________

 

NAME OF INSTITUTION PLANNING TO ATTEND: ________________________________________________

 

ADDRESS: _____________________________________________

 

              _____________________________________________

 

              _____________________________________________

 

              POSTAL CODE: ________________________________

 

PROGRAM OF STUDIES PLANNED: ___________________________________________________

 

NUMBER OF YEARS TO COMPLETE: _____________

 

CAREER GOALS: __________________________________________________________________________

 

________________________________________________________________________________________

 

*PLEASE ATTACH REQUIRED ESSAY TO THIS APPLICATION (SEE SCHOLARSHIP FUND PROGRAM FOR DETAILS)

 

I certify that the above information is true and correct to the best of my knowledge. In the event that I am awarded the Scholarship, I agree to the public release of my name for purposes of promotion for the Alberta Beach & District Agricultural Society.              

 

 

SIGNATURE OF APPLICANT: ________________________________________________        DATE: ________________________________