APPLICATION FORM
ALBERTA BEACH & DISTRICT AGRICULTURAL SOCIETY
SCHOALRSHIP FUND APPLICAITON FORM
NAME: __________________________________________________________________________________
MAILING ADDRESS: ___________________________________ DATE OF BIRTH: ____________________
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POSTAL CODE: ______________________
EMAIL ADDRES: ______________________________________________________
PHONE NUMBER (S): __________________________________________________
NAME OF INSTITUTION GRADUATED FROM: _______________________________________________
YEAR OF GRADUATION: ______
ADDRESS OF INSTITUTION: ________________________________
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POSTAL CODE: ____________________
NAME OF INSTITUTION PLANNING TO ATTEND: ________________________________________________
ADDRESS: _____________________________________________
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POSTAL CODE: ________________________________
PROGRAM OF STUDIES PLANNED: ___________________________________________________
NUMBER OF YEARS TO COMPLETE: _____________
CAREER GOALS: __________________________________________________________________________
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*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: ________________________________
