UPPER GRAND LEARNING FOUNDATION

500 Victoria Road North, Guelph, Ontario N1E 6K2

UGLF SCHOLARSHIP APPLICATION FORM

Please forward your completed application form to the address above.

School Name ____________________________________________________________

Applicant Name ____________________________________________________________

Address ____________________________________________________________

____________________________________________________________

PART I - TO BE COMPLETED BY APPLICANT AND FAMILY

Name of post secondary institution in which you have enrolled ___________________________

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Course of study/major ___________________________________________________________

Name of degree/diploma/certificate when course completed _____________________________

Name of parent(s)/guardian(s)_____________________________________________________

Address of parent(s)/guardian(s)____________________________________________________

______________________________________________________________________________

Occupation(s) and business address(es) of parent(s)/guardian(s)

Mother/guardian________________________________________________________________

Father/guardian ________________________________________________________________

Approximate total household income $______________________________________________

Name(s) and age(s) of persons totally or partially dependent on parent(s) or guardian(s)

______________________________________________________________________________

______________________________________________________________________________

Total estimated cost of your post-secondary course to completion $________________________

Amount available from your own or your family’s resources $____________________________

Amount of assistance expected from OSAP or Canada Student Loan $_____________________

Name and amount from any other scholarships/bursaries (eg. entrance scholarships)$__________

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DECLARATION:

The undersigned applicant, hereby applies for a scholarship through the Upper Grand Learning Foundation, and declares that, to the best of their knowledge, the information given in this application, is true in all respects. The parent/guardian declares that all information concerning household income and dependents is correct. PLEASE NOTE: Unless our scholarship recipients ask to remain anonymous, this signed application form includes the right of Upper Grand Learning Foundation to publish their names and home school on our web site and other communication materials that may be created to promote the foundation.

Date: ________________________

_______________________________ ___________________________________

(signature of applicant) and (signature of parent/guardian)

PART II - TO BE COMPLETED BY SCHOOL

Please outline the academic accomplishments of the applicant, including any special achievements __________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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Add any additional comments that may help the selection committee with their evaluation

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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The above applicant is recommended for consideration as a recipient of an Upper Grand Learning Foundation Scholarship.

________________________ ____________________________________

(date) and (signature of principal/guidance head)

APPLICATION CHECKLIST - be sure you have enclosed: