Please scan and email completed application package to panderson@cbwc.ca or mail to Peter Anderson (5920 Iona Drive, Vancouver, BC V6T 1J6) before April 30, 2020.

1 Student Last Name:

Student First Name:

2

Student Mailing Address: Street:

City: Prov: P/C:

3 Student Telephone Number: Parent’s (First/Last) Name:

4 Date of Birth (m/d/r): Age:

5 Church Name: Grade:

6

Church Address: Street:

City: Prov: P/C:

7 Pastor/Youth Worker/Church Leader Name (please print):

8 Church Leader Email: Church Phone:

9

Describe the nature of the financial need (use back if needed):

10

Signature (Applicant or Pastor/Rep):

Date:

Please scan and email completed application package to panderson@cbwc.ca or mail to Peter Anderson (5920 Iona Drive, Vancouver, BC V6T 1J6) before April 30, 2020.