algonquin valley branch - adh.rcdsb.on.caadh.rcdsb.on.ca/.../special-applications-word.docx ·...
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ARNPRIOR COMMUNITY SAFETY PARTNERSHIP COMMITTEE AWARDS
SPECIAL APPLICATION FORM
NAME:_________________________________________________________________________
ADDRESS:_____________________________________________________________________
NAME OF POST-SECONDARY INSTITUTION:_________________________________________
NAME OF POST-SECONDARY PROGRAM:___________________________________________
COMMUNITY:
We are looking for a student who not only has good marks, but someone who is involved in their community. Please indicate what you have done in your community over the last four years. You can include any extra-curricular activities at your high school or outside of school.
Due to the fact that we don’t have the opportunity to meet all the applicants personally, here is your chance to let us know why you think you deserve this bursary. In about 100 words, tell us why you decided on law enforcement as your career choice and how you think you could use your authority to improve the world today.
ARNPRIOR & DISTRICT FISH & GAME CLUB:DON PIERCE and JEFFREY DRAPER MEMORIAL AWARDS
SPECIAL APPLICATION FORM
NAME: ________________________________________________________________________
Evidence of your active community service, including involvement in community work with an outdoor or environmental organization:
Write a 300+ word essay depicting a unique or humorous outdoor experience (attach pages if necessary):
ARNPRIOR REGIONAL HEALTH AUXILIARY BURSARIESFOR ALLIED HEALTH and NURSING
(please circle one)
NAME:______________________________________________________________________
NAME OF POST-SECONDARY INSTITUTION:______________________________________
NAME OF PROGRAM:_________________________________________________________
CAREER PLAN:_______________________________________________________________
Attach an extra sheet if more space is required.
Please outline where you have volunteered and how many hours you have done in the community.
List the extra-curricular activities, and their duration, that you have participated in, both in school and in the community.
What leadership roles have you experienced?
Have you done a co-op placement in the healthcare field? If so, where?Please describe your experience.
CHRISTIAN EDUCATION AWARD
SPECIAL APPLICATION FORM
NAME: ________________________________________________________________________
NAME OF POST-SECONDARY INSTITUTION (for further training in the Christian Education
Field):_________________________________________________________________________
List or describe ways in which you have been actively involved in Christian activities in church, school and/or community.
Grade 12 average: _______________________________________________________________
Reasons for financial need (if applicable).
GLOBAL AWARENESS AWARD
SPECIAL APPLICATION FORM
NAME: ________________________________________________________________________
Outline how your extensive extra-curricular reading of books has expanded your horizons of awareness and has lead to a thoughtful understanding of one or more of the following topics:
The human story – including history, culture and religion – from perspectives outside of the English-speaking world. Issues such as relationship between humanity and nature, especially in relation to the challenges of climate change; the loss of human respect for other manifestations of life and for the biosphere as a whole; ecologically and ethically sound economics; fully sustainable use of natural resources; and/or geopolitics. A critical examination of one or more aspects of contemporary technology such as geo-engineering, social media, robotics, artificial intelligence, etc.
GLOVER DENTAL TEAM WELLNESS AWARD
SPECIAL APPLICATION FORM
NAME: ______________________________________________________________________
NAME OF POST-SECONDARY INSTITUTION: ______________________________________
NAME OF PROGRAM: _________________________________________________________
Outline how you meet the personal criteria of this award. (Conditions 1 and 2)Attach page(s) if needed.
Outline your plans for financing your education.
The HARRY and JANET CLANCY ENDOWMENT
SPECIAL APPLICATION FORM
NAME: ______________________________________________________________________
ADDRESS: __________________________________________________________________
POST SECONDARY INSTITUTION: __________________________________________
POST SECONDARY PROGRAM: ____________________________________________
BEST SIX 4U MARKS (include first term final marks and list current courses)
COURSE MARK
________________________________________ _____________
________________________________________ _____________
________________________________________ _____________
________________________________________ _____________
________________________________________ _____________
________________________________________ _____________
AVERAGE = _____________
PROOF OF ACCEPTANCE (not just application) MUST BE ATTACHED!
J.J. NEILSON FAMILY ENDOWMENT FUND
SPECIAL APPLICATON FORM
(APPLICATION FOR STUDENTS ATTENDING ARNPRIOR DISTRICT HIGH SCHOOL)
NAME OF APPLICANT: __________________________________________________________
Address: ________________________________________ Town: _________________________
Province: _______________ Postal code: ______________ Phone:________________________
Birthdate of Applicant: ____________________________________________________________
Name of University you plan to attend next year: ________________________________________
What University program will you be enrolled in next year? ________________________________
PROOF OF ACCEPTANCE MUST BE ATTACHED
To assist the selection committee, please attach a letter indicating:
a. future career plans;
b. participation in co-curricular activities (in school, community, etc.); and
c. financial need.
Please return completed application by April 24, 2017 and all other requested information as quickly as possible to Student Services.
J.J. NEILSON FAMILY ENDOWMENT FUND
SPECIAL APPLICATION FORM
(APPLICATION FOR STUDENTS NOW IN UNIVERSITY)
NAME OF APPLICANT: ___________________________________________________________
BIRTHDATE OF APPLICANT: ___________________________ S.I.N.:_____________________
MAILING ADDRESS: _____________________________________________________________
PHONE NUMBER: _______________________________________________________________
NAME OF PARENT: _____________________________________________________________
NAME OF UNIVERSITY YOU ARE ATTENDING: ______________________________________
UNIVERSITY COURSES COMPLETED: (PLEASE ATTACH TRANSCRIPT)
NAME OF UNIVERSITY YOU PLAN TO ATTEND NEXT YEAR: ___________________________
WHAT UNIVERSITY PROGRAM WILL YOU BE ENROLLED IN NEXT YEAR?
______________________________________________________________________________(PROOF OF ACCEPTANCE MUST BE ATTACHED)
To assist the selection committee, please attach a letter indicating:
a. future career plans;
b. participation in co-curricular activities (in university, community, etc.); and
c. financial need.
Please return completed application and all other requested information by June 15 th to:
Head, Student Services DepartmentArnprior District High School59 Ottawa StreetArnprior, ON K7S 1X2
KATIE FRASER MEMORIAL AWARDSPECIAL APPLICATION FORM
NAME OF STUDENT: ____________________________________________________________
Write 300 words to tell how you have challenged stereotypes and blazed your own path to achieve goals. Be sure to tell how determination and attitude helped you achieve the goals.
KATRINA (KAY) LYMAN MEMORIAL AWARDSPECIAL APPLICATION FORM
NAME OF STUDENT: ____________________________________________________________
Write 300 words about the importance of family and where you see yourself heading in the future. The target audience is teenagers.
APPLICATION FOR ARNPRIOR KNIGHTS OF COLUMBUS AWARD
PART 1 (TO BE COMPLETED BY STUDENT)
Name: _________________________________________________________________________
Street: _________________________________________________________________________
Town: _________________________________ Telephone No.:______________ Age:________
College or University: _____________________________________________________________
Type of Course: _________________________________________________________________
Length of Course: ________________________________________________________________
Signature: ____________________________________________ Date:____________________
PART 2 (TO BE COMPLETED BY PARENT)
Since the award is based in part on financial need, the following information is required (IN FULL). This information will be kept strictly confidential.
Father / Step-Father Mother / Step-Mother
Name:
Occupation:
Employer:
No. of Years:
Yearly Gross Income:
No. of dependent children (other than the applicant) in the family: __________________________
No. of other children at College or University:__________________________________________
Signature:_______________________________________________ Date:_________________
LIEUTENANT GOVERNOR’S COMMUNITY VOLUNTEER AWARD
This application will be destroyed after the presentation of awards.
SPECIAL APPLICATION FORM
NAME: ________________________________________________________________________
List or describe ways in which you have contributed to the community or have been actively involved as a volunteer.(Attach extra pages if necessary)Volunteer Contribution to Community
If used as part of 40 hours
Dates / Length
Hours Description of responsibilities
LISA AMANDA AGNES ROESLER MEMORIAL AWARDSPECIAL APPLICATION FORM
NAME OF STUDENT: ____________________________________________________________
NAME OF POST SECONDARY INSTITUTION: ________________________________________
NAME OF PROGRAM: ___________________________________________________________
Describe in 300 words how your choices in life have positively impacted you and/or your community or how you have learned from your choices to make better decisions in the future.
SPECIAL APPLICATION FORM
AVAILABLE as .pdf
Open under separate tab.
ONTARIO POWER GENERATION
SECONDARY SCHOOL STUDENT ACHIEVEMENT AWARDSPECIAL APPLICATION FORM (5 PAGES)
NAME: ________________________________________________________________________
The applicant must have complete the OSSD and be proceeding to a post secondary institution.
1. Education Focus: circle one
Engineering/Electronics Science (not the health field)
Environment Mathematics Physics
Business Information Technology
State specific program title: _________________________________________________
2. Post secondary Institution:__________________________________________________
3. Grade 12 Average_________________________________________________________(minimum 75%)
4. High School Awards (list below)
Volunteer Work, Community Involvement, and Extra-curricular Activities:
Evidence of Leadership Skills:
Are you legally eligible to work in Canada? Yes No
_____________________________________________________ _______________________ Signature Date
Attachment 1ONTARIO POWER GENERATION
Secondary School Student Achievement Award (SSSAA) Award Criteria
Two annual awards per Ontario Secondary School in Ontario Power Generation (OPG) designated communities hosting our major plant / generating station sites.
$250.00 per award. Awarded to a student who has completed their Grade 12 with a specific focus on further College or
University study in any of the following fields: Engineering, Science, Trades and Technology (i.e. Electrical Engineering, Industrial Mechanical/Millwright, Power Engineering, Instrumentation Engineering), Mathematics, Physics, Environmental Studies or Business.
Requires strong oral and written communication skills. Demonstrated leadership skills. Is of good academic standing (minimum B average). Involved in extra-curricular activities and/or community volunteerism. Signed Consent & Release form from recipient(s) along with their graduation photograph must be
provided to the OPG representative below for use in OPG reports and community advertorials on the SSSAA.
Administrative Process The award candidate is nominated through the Secondary School internal awards selection
program. Following nomination, the School Awards Officer/School Board Representative provides a
completed Recipient Profile Sheet (attached) along with a signed consent and release form (also attached) to the OPG representative listed below. The OPG representative must receive this at least 3 weeks in advance of the graduation ceremony.
Ontario Power Generation will provide the designated School Boards (Public and Separate) with a cheque for the award winners in the qualifying Secondary Schools. School Boards will set up a Trust Fund and will re-issue the award cheques in each student’s name so that OPG may be charitably receipted for its support. The Secondary Schools will present the cheques according to their specific award/graduation processes.
Ontario Power Generation will arrange (where possible) for a company representative to be present at the graduation awards ceremony to present the OPG SSSAA to the successful candidates.
An Award Certificate of congratulations from OPG will also be provided to the students at the ceremony.
The School Board / School will issue charitable receipts to Ontario Power Generation for all student awards in each calendar year.
Please direct any correspondence and all receipts to:
Attn: Cindy ClarkeManager, Corporate Citizenship ProgramOntario Power Generation, 700 University Avenue, H19 E4Toronto, Ontario M5G 1X6Phone: (416) 592-8775Fax: (416) 592-8788Email: [email protected]
Attachment 2
ONTARIO POWER GENERATION
SECONDARY SCHOOL STUDENT ACHIEVEMENT AWARD (SSSAA)
Recipient Profile Sheet
School Board: Renfrew County District School Board
School Name: Arnprior District High School
School Mailing Address: 59 Ottawa St., Arnprior, ON K7S 1X2
School Contact Person/Awards Officer: Phil Moore
E-mail: [email protected]
Telephone: (613) 623-3183 ext. 229
Fax: (613) 623-6973
Award Winner’s Name:________________________________________________________
Age (re: consent and release form):______________________________________________
Education Focus Area (i.e., Engineering, Science, Environment, Technology, Math and
Physics):____________________________________________________________________ Academic Standing:___________________________________________________________
Other Secondary School Awards:________________________________________________
Post-Secondary Institution (College/University):_____________________________________
Post-Secondary Study Program (Environmental Studies, Engineering, et al):_______________
___________________________________________________________________________
…2
Recipient Information (assume you are the winner)
Secondary School
- 2 -
Other Interests:_______________________________________________________________
___________________________________________________________________________
Volunteerism/Community Involvement:____________________________________________
___________________________________________________________________________
Leadership Skills:_____________________________________________________________
___________________________________________________________________________
Date and Time: Thursday, June 29, 2017 at 4:00 p.m.
Address/Location Within School: McEwen Gym, ADHS, 59 Ottawa St., Arnprior
Required Time of Arrival for OPG Presenter:_______________________________________
School Contact: Jill Reid, (613) 623-3183 ext. 225, [email protected]
Departure Time for OPG Presenter:_______________________________________________
Consent and release form completed by the award recipient and enclosed: Yes No
Graduation picture enclosed:Yes No
The School Contact/Awards Officer in consultation with the award recipient should complete this form. The completed forms should then be submitted along with the signed consent and release form and graduation photograph through the school awards process/School Board to the following OPG contact:
Cindy ClarkeManager, Corporate Citizenship Program
Ontario Power Generation700 University Avenue, H19 E4
Toronto, OntarioM5G 1X6
Telephone No.: (416) 592-8775Fax No.: (416) 592-8788
E-mail Address: [email protected]
Should you have any questions concerning the form or process, please contact the above noted OPG representative.
Graduation Ceremony
Consent and Release I hereby consent to Ontario Power Generation Inc. its agents, successors and
assigns (collectively the "Corporation") using, storing, retrieving, duplicating or reproducing (i) my
name; (ii) photographs, artwork or writing provided by me; (iii) photographs, artwork or videos in
which I appear; and (iv) recordings made of my voice, in any media or territory, for purposes the
Corporation deems suitable.
I hereby waive and release the Corporation from and against any and all claims
which I or my successors have or may have, arising out of such use, storage, retrieval, duplication
or reproduction more fully described in the above paragraph, including but not being limited to
invasion of privacy, appropriation of personality, infringement of copyright or moral rights, or
defamation. I acknowledge that no remuneration will be paid to me at any time.
Organization (please print): Arnprior District High School
Individual (please print):
Project, Event or Award: High School Graduation Award, 2017
Address: 59 Ottawa Street, Arnprior, ON K7S 1X2
Signed: Date:
Witness: Date:
If under eighteen, parent or guardian must also sign.
Name (please print):
Address:
Signed: Date:
Witness: Date:
Please return this completed form to the Ontario Power Generation contact listed below: Name: Cindy Clarke Title: Manager, Corporate Citizenship Program, OPGAddress: 700 University Avenue, 19th Floor E4, Toronto ON M5G 1X6Telephone: (416) 592-8775 Fax: (416) 592-8788Email: [email protected]
1PILON FAMILY CITIZENSHIP AWARDSPECIAL APPLICATION FORM
NAME OF STUDENT: ____________________________________________________________
NAME OF COLLEGE: ____________________________________________________________
NAME OF PROGRAM: ___________________________________________________________
SERVICE TO SCHOOL AND COMMUNITY:List the activities you have participated in. Include your role and duration of involvement.
FINANCIAL NEED:Outline your plans for financing your education.
RENFREW COUNTY ROAD SUPERVISORS ASSOCIATION
SPECIAL APPLICATION FORM
NAME OF STUDENT: ________ ____________________________________________________
ADDRESS: _____________________________________________________________________
NAME OF COLLEGE or UNIVERSITY: _______________________________________________
NAME OF PROGRAM: ___ ________________________________________________________
PLEASE CHECK THE APPLICABLE COURSE OF STUDY YOU WILL FOLLOW:
Engineering – Civil Preferred (Degree or Diploma) Environmental Technician/Technologist Survey Technician/Technologist GIS/CAD Technician/Technologist Trades
o Heavy Equipment Operatoro Heavy Equipment Technician (Mechanic)o Truck/Coach Technician (Mechanic)
The Royal Canadian Legion Branch 174
POPPY BURSARY APPLICATION FORM
Conditions1. The applicant must have received the Ontario Secondary School
Diploma.2. The applicant must be proceeding or attending a Post Secondary
Education at a University or College.3. The recipient shall be chosen by The Royal Canadian Legion
Branch 174 Bursary Committee.
Value: $500.00
Poppy BursaryEligible to students who have immediate family (great grandfather/mother; grandfather/mother; father, mother, brother, sister) who are serving or have served in the Canadian Armed Forces.
Name of Immediate Family Member: _____________________________
Relationship: _____________________________________________
Applicants Status (check) Son or Daughter of: Legion Member Yes __ No ___ Membership Number: ____________
Applicants Information
Name: ___________________________________ Age: _________
Address: ________________________________ Town: ____________
Province: _____ Postal Code: __________ Phone: ___ - ___ - ____
Parents Name: __________________________ Phone: ___ - ___ - ____
1 of 2
Please check: University: __________ College: ________
Name of Institution you plan on attending: ___________________________
Location: __________________
Type of course enrolled: ______________________________________
Length of course: _______________
What school activities have you been involved in? ____________________
_____________________________________________________________
What activities outside school have you been involved in? ______________
_____________________________________________________________
Have you participated in Legion Poster, Poems, Essay Competitions: _____
If yes, please advise how you fared out. _____________________________
Have you participated in Legion Public Speaking Competitions: _________
If yes, please advise how you fared out. _____________________________
In thirty words or less please advise why you should receive this Bursary:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Oh behalf of the Executive of the Royal Canadian Legion Branch 174, Arnprior “Thank You” for submitting this application. This document will be destroyed at the conclusion of the Branch Bursary Committee meeting that determines the winners of the Bursaries.
Applicants Signature: ___________________________
Note: The Legion reserves the right to authenticate all information pertaining to the application prior to any decision being made.
1
The Royal Canadian Legion Branch 174
COMMUNITY BURSARY APPLICATION FORM
Conditions1. The applicant must have received the Ontario Secondary School
Diploma.2. The applicant must be proceeding or attending a Post Secondary
Education at a University or College.3. The recipient shall be chosen by The Royal Canadian Legion
Branch 174 Bursary Committee.
Value: $500.00
Community BursaryEligible to students who are graduating/have graduated from Arnprior District High School and reside in the Town of Arnprior or surrounding area.
Applicants Status (check)
Son or Daughter of Legion Member Yes ___ No ___
Membership Number: ____________
Applicants Information
Name: ___________________________________ Age: ______
Address: _________________________________ Town: ____________
Prov: _____ Postal Code: _______ Phone: _____ - _____ - _______
Parent’s Name: _________________________ Phone: ___ - ___ - ____
1 of 2
Please check: University __________ College: ________
Name of Institution you plan on attending: ___________________________
Location: __________________
Type of course enrolled: ______________________________________
Length of course: _______________
What school activities have you been involved in? _________________________________________________________________________________
What activities outside school have you been involved in? ___________________________________________________________________________
Have you participated in Legion Poster, Poems, Essay Competitions: _____
If yes, please advise how you fared out. _____________________________
Have you participated in Legion Public Speaking Competitions: _________
If yes, please advise how you fared out. _____________________________
In thirty words or less please advise why you should receive this Bursary:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Oh behalf of the Executive of the Royal Canadian Legion Branch 174, Arnprior “Thank You” for submitting this application. This document will be destroyed at the conclusion of the Branch Bursary Committee meeting that determines the winners of the Bursaries.
Applicants Signature: ___________________________
Note: The Legion reserves the right to authenticate all information pertaining to the application prior to any decision being made.
TOWNSHIP OF MCNAB/BRAESIDE – BURSARY
SPECIAL APPLICATION
NAME OF STUDENT: ____________________________________________________________
CIVIC ADDRESS: _______________________________________________________________
Please check the appropriate program and provide the specific program you are registered in / applied to.
Political Science ____________________________________________________
Public Administration _________________________________________________
Agriculture _________________________________________________________
Recognized Trade ___________________________________________________
Environmental Studies ________________________________________________
Rural Studies _______________________________________________________
History / Heritage ____________________________________________________
Be sure you have filled in of your community involvement and/or volunteer work and your extra-curricular involvement (within school or community or both) on your general application.
TRISHA LOUISE SMITH MEMORIAL AWARDSPECIAL APPLICATION FORM
NAME OF STUDENT: ____________________________________________________________
NAME OF UNIVERSITY ATTENDING: _______________________________________________
Describe how the following sentence applies to you.
“A student who has given his/her personal best in athletics.”
Describe how you have displayed the ability to rise to a challenge.
Outline your involvement in school activity.(You may attach a photocopy of the personal information on your general application form.)
Describe how you have displayed your compassion for others at school or in the community.