Application for Entrance Scholarships and Bursaries Regular Session 2012-2013 IMPORTANT INFORMATION:

Brandon is in the process of changing from Grade 12 marks to Grade 11 marks as the criteria for awarding Entrance Scholarships. In order to be guaranteed consideration for all entrance scholarships, you must ensure that a transcript of your Grade 11 marks is submitted to the Senate Scholarship Office by March 1, 2012. (After that date, you will still be considered for Board of Governors Entrance Scholarships on the basis of your Grade 12 marks.)

If you receive an Entrance Scholarship, you must register for courses no later than August 6, 2012 in order to retain the award.

Bursaries – will continue to be awarded on the basis of Grade 12 marks. Student Aid information must be received in the Senate Office by September 17th, 2012.

Please forward Letters of Reference to the Senate Scholarship Office for awards that require additional information from students regarding their extra-curricular activities, farming background, etc.

Scholarships are awarded on the basis of academic achievement. Bursaries are based on financial need as well as academic achievement. The awarding of an entrance scholarship and/or bursary is contingent upon attendance at Brandon University during the Regular Session 2012-13. For major awards, students will be required to register in 24 credit hours in the 2012-2013 Regular Session, unless the individual award terms specify a different number of credit hours. (Some awards can be held with fewer credit hours).

Please note: Values of awards are subject to change.

Brandon University Board of Governors Entrance Scholarships – to be awarded to graduates of accredited Canadian high schools who are entering first year at Brandon University. Students who are entering Brandon University with advanced university standing obtained through International Baccalaureate, Advanced Placement, dual credit, or university courses completed concurrently while full-time high school students are also eligible for this award.

Board of Governors Entrance Scholarships will be awarded according to the following schedule:

Tier 1 – Average greater than or equal to 95% - $2000 Tier 2 – Average greater than or equal to 92.5% - $1700 Tier 3 – Average greater than or equal to 90% - $1400 Tier 4 – Average greater than or equal to 87.5% - $1100 Tier 5 – Average greater than or equal to 85% - $800

Scholarship eligibility will be based on grade 11 marks if students apply before March 1 of the year they graduate from high school. Students who apply after March 1 shall have their scholarship eligibility assessed on final (i.e. June) grade 12 grades. Students are automatically 2

considered for BOG scholarships upon admission and do not need to specifically apply for them, but in order to be considered on the basis of Grade 11 marks, you must ensure that a Grade 11 transcript is received by the Scholarship Office no later than March 1. Note: Students who are awarded Brandon University Board of Governors Entrance Scholarships on the basis of one or more grade 11 (30s) courses may have their award increased should grade 12 averages at graduation result in a higher award. In no case shall the award be reduced.

Brandon University Board of Governors Entrance Scholarships: Advanced Placement Courses: To be awarded to graduates of accredited Canadian high schools entering first year at Brandon University who have completed one or more Advanced Placement (AP) courses as part of their high school program. Students will be awarded $250 for each AP course with a grade of 5 and $175 for each AP course with a grade of 4. These amounts will be in addition to any amounts awarded under the Brandon University Board of Governors Entrance Scholarships. (Please ensure that a copy of your College Board transcript is provided to the Scholarship Office or the Admissions Office.)

Brandon University Board of Governors Entrance Scholarships: International Baccalaureate Courses: To be awarded to graduates of accredited Canadian high schools entering first year at Brandon University who have completed either the full International Baccalaureate (IB) Diploma or individual IB courses as part of their high school program. Students who have completed the entire IB Diploma will receive scholarships in the following amounts, depending upon their aggregate IB score; they are eligible for this scholarship amount or a Board of Governors Entrance Scholarship, whichever is higher, but not both. Score Amount 43-44 $2800 40-42 $2500 37-39 $2200 34-36 $1900 31-33 $1600 28-30 $1300 26-27 $1100

Students who have completed one or more individual IB courses will receive a scholarship for excellence in individual courses according to the following scale: For each grade of 7 on the higher level: $250 For each grade of 6 on the higher level: $200 For each grade of 5 on the higher level: $150 For each grade of 7 on the standard level: $200 For each grade of 6 on the standard level: $100

These awards are in addition to any amounts granted for completing the IB Diploma Program or for students receiving a Brandon University Board of Governors Entrance Scholarship. (Please ensure that a copy of your International Baccalaureate transcript is provided to the Scholarship Office or the Admissions Office.)

Entrance students will automatically be considered for the following scholarships (Grade XI marks must be in the Senate Scholarship Office by March 1st, 2012):

Chernoff Family Awards - Michael N. Chernoff has established the Chernoff Family Award in honour of Dorine Marjorie Chernoff (nee Dennison, B.A., 1951, University of at Brandon). The award also honours Dorine’s parents, Agnes and Roland Dennison, who encouraged Dorine and provided the environment for Dorine to attain her university degree at Brandon. The Chernoff family is a strong supporter of education for all Canadians and to this end has established similar support for students at other and high schools in Canada. The benefactors believe that the legacy of these awards will be an enduring benefit to our country’s citizens, flowing from the future success of the award recipients. 3

The Chernoff Family Award will be granted to the top two entering students each year. The award may be renewable a maximum of three times, provided that the student maintains a minimum grade point average of 3.5 and is registered in at least 24 credit hours at Brandon University...... 2 x $7,500

James Christie Memorial Scholarship -- awarded to a graduate of Souris Collegiate with a Grade l2 average of “B” or greater who attends B.U. in the year of his or her high school graduation. If no suitable candidate is available from Souris, the scholarship may be awarded to a Southwestern Manitoba graduate (renewable for a second year) ...... $l,245

William & Elizabeth Ferguson Memorial Entrance Scholarship -- established by Craig Ferguson (Arts l950) in memory of his parents. Awarded to a student applying for admission to the Faculty of Arts who has a high academic standing...... $3395

G.F. MacDowell Entrance Scholarships -- awarded to graduates of accredited Canadian high schools. Students with the best high school averages above 80% will be considered...... 4 x $1,062

Professor G. MacNeill Memorial Scholarship -- awarded to a Province of Manitoba student entering the program of Arts at Brandon University with the highest proficiency in a language or languages other than English, in his or her Grade XII studies ...... $984

Robert and Vesta Daniels Entrance Scholarship -- provided by the Daniels’ family. Awarded to a student entering Brandon University who has graduated from an accredited rural high school in Southwestern Manitoba...... $947

Crane Steel Structures Entrance Scholarship – to be awarded to an entering student who demonstrates high academic potential in the final year of high school studies ...... $TBA

Entrance Scholarships Requiring Application (Both the application form and Grade XI marks must be received by March 1st, 2012.)

In addition to academic excellence, scholarships in this category require applicants to meet certain special conditions, such as a record of excellence in extracurricular activities or coming from a farming background. Please read the terms carefully and check the box next to any award(s) for which you wish to apply. Also, please include a letter (from yourself) describing how the specific terms apply to you (for example, a listing of your extracurricular activities). As noted in the terms for some awards, applicants may also be required to provide letters of reference (for example in regard to extracurricular activities).

Charles W. Burns Scholarships in Pre-Medicine - awarded to Canadian citizens who are residents of rural Manitoba: (a) who possess an accredited Manitoba high school diploma; (b) who have demonstrated a balance of outstanding academic achievement and extracurricular activity during their high school studies, having obtained a minimum 80% average upon graduation; (c) who have not attended a post-secondary institution; and (d) who register in a minimum of 24 credit hours in a Faculty of Science degree program at Brandon University and undertake a program of studies that will qualify them to apply for entry to a Canadian medical school. Applicants must complete this application form and, if requested, be prepared to submit to an interview. Preference will be given to students from farming communities. Letters of reference from the student’s high school principal and a reputable member of the community will be required to explain the student’s extra-curricular activities. The Charles W. Burns Scholarships in Pre-Medicine at Brandon University are renewable twice. Recipients must remain registered in a minimum of 24 credit hours in the Faculty of Science at Brandon University, undertaking a program of studies that will qualify them to apply for entry to a Canadian medical school. In addition, students must maintain a minimum 3.50 cumulative grade point average ...... $5,000

Donald Burns and Louise Berlin Family Scholarships in the Geosciences -- to be awarded on the basis of academic performance to students from southwestern Manitoba, who are entering Brandon University with the intent to pursue the Geosciences. The successful applicants will receive $750 upon acceptance to 4

Brandon University and registration in courses 42:160 and 42:161, or their equivalent, and an additional $1250 upon successful completion of their first year and registration in at least 9 credit hours of Geology as a Geosciences major in year two of the program. These awards may not be shared ...... 3 x $TBA

Louis Riel Scholarships at Brandon University -- To be awarded to Manitoba residents of Metis status. Please obtain a separate application form from the Senate Office at Brandon University ...... 6 x $1,500

John & Catherine Robbins Entrance Scholarships -- awarded to a student who, in addition to academic excellence, has a record of constructive extra-curricular activities in his or her school and/or community. A letter of recommendation from your Principal and another letter from a community member explaining your extra-curricular activities are required to complete your application ...... 2 X 2642

Simplot Canada Ltd. Entrance Scholarships -- awarded to a student who has lived on a farm and/or has been actively involved in a farm operation in Manitoba or Eastern Saskatchewan east of Highway #6. The student must submit two letters of reference to support the application form. These letters must state that the applicant has lived on a farm and/or has been actively involved in a farm operation in the area designated above...... 2 x $750

Terry Penton Memorial Scholarship -- donated by friends of Terry Penton for a graduate of a Southwestern Manitoba high school. A letter of recommendation from the student’s Principal testifying to the student’s exemplary community service and proven ability (not less than a B average or equivalent) must accompany the application...... 2 x $750

E. Jay Watson Memorial Entrance Scholarships - to be awarded to top entering students from within the following designated region of rural Manitoba: a) West: Saskatchewan Border; b) South: US border, c) North: South Western part of Lake Manitoba, and Southern end of Lake Winnipegosis, including the Swan River Valley and d) East: Provincial Highway 34. Preference will be given to students from a farming or agribusiness background. Students must be registered in at least 30 credit hours (Please forward a letter describing your involvement in farming or agribusiness background) ...... 2 x $1,000

Sarah Harriet Hall Memorial Academic Scholarships -- were bequeathed to Brandon University by Sarah Harriet Hall, a graduate of Brandon College in l92l. Scholarships will be awarded each year to the best student entering from an accredited high school in the first year of each of the following four undergraduate degree programs: B.A. (including BBA, BFA, and BPES), B.Sc. (including ADES and B.Sc. in Environmental Science), School of Health Studies (including BIHHS) and B.Mus. The students must have demonstrated academic excellence in high school as well as proficiency in extra-curricular activities. Letters of Reference and recommendations must be submitted by the student’s high school Principal and a reputable member of the community in which the student lives. These scholarships are renewable provided that students: a) remain in the same faculty, b) maintain a 3.5 g.p.a. and c) are registered in a full course load (30 credit hours except under special circumstances at Brandon University ...... 4 x $l,000

Gerdau MRM Steel Inc. Annual Scholarship -- provided by Gerdau MRM Steel Inc. To be awarded with preference given to a child of an employee of Gerdau MRM Steel Inc. If no suitable candidate is available then the scholarship will be awarded to an undergraduate Aboriginal student who shows outstanding performance in his/her studies ...... $1,000

James Harvey Tolton Memorial Scholarship -- awarded to a Senior 4 graduate of a southwestern Manitoba high school entering first-year Agriculture at Brandon University...... $642

Donna & Bill Parrish Scholarship for Aboriginal Students -- to be awarded to an Aboriginal student of strong academic merit enrolled in full-time study at Brandon University ...... $1500

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Pallister Entrance Scholarships - to be awarded to deserving entrance students from the Central Plains region, including the communities of Portage, Gladstone, Treherne, Crystal City, Winkler and Carman...... 4 x $428

IBEW Local 2034 – CFL Manitoba Council Commemorative Scholarship - to be awarded to a dependent of a member in good standing of the IBEW Local 2034, who is entering any Faculty at Brandon University with the highest proficiency in his/her Senior 4 studies. A letter of support from IBEW Local 2034 must accompany the student’s application ...... $588

Manitoba Government Employees Association BUNASA Local 2003 Scholarship -- awarded to a dependent of a Brandon University MGEU member who is entering any Faculty at Brandon University with the highest proficiency in her/his Senior 4 studies. In the event that no one is eligible, this award should go to the best Second, Third, or Fourth Year student (in that order) who is a dependent of a Brandon University MGEU member(Please forward information on who the BU MGEU member is to the Senate Office)$TBA

G.F. MacDowell Entrance Scholarships in Political Science -- provided by the estate of G.F. MacDowell, Professor Emeritus. Awarded to an outstanding high school student entering Brandon University and taking a first year Political Science course ...... 2 x $100

Delameter-Wood 50th Anniversary Scholarship -- provided by family and friends of John and Iva Wood (nee Delameter, class of 1944) in honour of their 50th Wedding Anniversary, celebrated on June 21, 1997. Mr. & Mrs. Wood were both high academic achievers in their formal education and have shared a love of learning throughout their lives together. The scholarship is to be awarded annually to a student entering Brandon University who has demonstrated academic excellence in high school and who has made a positive contribution to his/her community as supported by two letters of reference. $100.

Xerox Canada Award - awarded to a Native Canadian student who has registered in a Business Administration course(s) during the Regular Session. The recipient may be either an entering or returning student...... $2852

Afghanistan Mission Memorial Awards -- These awards recognize the sacrifice of Canadians within the theatre of combat, in peacekeeping and in diplomatic service in Afghanistan. These full tuition undergraduate awards are available to any students whose parent or legal guardian was a member of Canadian Forces staff or Canada’s federal diplomatic corps (i.e. department of Foreign Affairs or International Trade) and was killed as a result of an operational mission in Afghanistan (as of 2001/2002) or in training for such a mission. These awards are open to full-time and part-time undergraduate students in their first degree. To be eligible to receive the award, a student must also have graduated from high school and undertake the first year of study prior to the age of 21. These awards are renewable to a maximum of 120 credit hours provided that the student remains in good standing (minimum 2.0 c.g.p.a.) ...... $Tuition

Entrance Scholarships for Students entering the School of Music Students entering the School of Music are eligible for all of the foregoing awards, but there are many other awards specific to music students. As these require an audition and a recommendation from the School of Music, music students are asked to contact the School of Music directly for information on such awards.

ENTRANCE BURSARIES FOR STUDENTS IN NEED: Please check one or more.

Please read the terms of the following bursaries carefully and check all those that apply to your situation. You will note that some of the terms are very open ended, while others require that you meet specific criteria or that you are applying for a specific program of courses. If you wish to be considered for those bursaries with specific criteria, please attach a letter outlining how you meet these criteria. Please note that all bursaries require you to complete the financial need section of this form.

All bursaries require students to meet academic standards as well as demonstrating a financial need. For the academic aspect of bursary qualification, we will use your Grade 12 marks as submitted to the Admissions Office to confirm your admission. 6

Bursary consideration is based, in part, on information supplied to you by Manitoba Student Financial Aid, and you have until September 17 to provide us with a copy of this information (see the Financial Need Information section of this form). Due to the complexities involved in processing this data, plus all of the other information required for specific bursaries, it is often well into the term before we can notify successful applicants. We know how important this notification is to you, and we promise to do everything we can to see that it happens as soon as humanly possible.

Phillippa Saul Memorial Bursaries in Arts and Music -- to be awarded to students in financial need enrolled in any year of study in the Faculty of Arts or the School of Music at Brandon University. 1 x $2400 (Arts); 1 x $2400 (Music)

Anne Selley (nee McKillop) and Annie Truesdall Bursaries -- each bursary is to be awarded to an entering or returning student in the Faculty of Arts. A past recipient who maintains a minimum 3.25 gpa and who reapplies for this bursary will receive preference. This bursary may be held a maximum of four times ...... 3 x $2000

Donald Burns and Louise Berlin Family Bursaries -- to be awarded, with preference, to students from south western Manitoba, with financial need who are entering Brandon University with the intent to pursue the Geosciences. The successful applicants will receive $750 upon acceptance to Brandon University and registration in courses 42:160 and 42:161, or their equivalent, and an additional $1250 upon successful completion of their first year and registration in at least 9 credit hours of Geology as a Geosciences major in year two of the program. These awards may not be shared...... 2 x $TBA

Manitoba Blue Cross George J. Strang Scholarship -- awarded to a student with an accredited Manitoba high school diploma who demonstrates financial need and satisfactory academic performance. The recipient must be registered full-time in either Education or Health Studies at Brandon University. Preference will be given to students who live with special needs and to Aboriginal students. Normally, these awards shall only be given to students who are not receiving any other award, bursary or scholarship of more than $1000 (This scholarship requires the student to complete the financial section of the form) Applicants must submit a letter stating the manner in which they meet the criteria, and (where applicable) attesting to Aboriginal status...... $3000

Lois Hunter Memorial Scholarship -- awarded to an outstanding student entering or returning to the Faculty of Science who demonstrates financial need and who has resided in the Westman area over the past year (This scholarship requires the student to complete the financial section of the form) ...... $1,200

Louis Riel Institute Bursaries at Brandon University -- To be awarded to Manitoba residents of Metis status. Please obtain a separate application form from the Senate office Brandon University ...... #TBA x $3000

Total EyeCare Bursary -- to be awarded to an entering or returning student in the Bachelor of Science degree program who has declared an intent to pursue a career in Optometry and who is enrolled in relevant courses. A past recipient who maintains a minimum “B” average in these courses and who reapplies for this bursary will be given preference. If there is no recipient eligible under these conditions, then this bursary may be awarded to a student in any science or related health care program. This bursary may be held a maximum of four times (Please submit a letter describing your intent to study Optometry.) $1153

BDO Dunwoody Business Administration Bursary -- awarded to: a) a student who has graduated from an accredited Canadian High School, who is entering first year as a full-time student pursuing studies in the Business Administration program; or b) if there is no eligible student in first year, then the bursary may be awarded to a student in the Faculty of Arts, or c) to a student who is chosen by the Scholarship Committee of Brandon University ...... $1,068

Manitoba Industry, Economic Development and Mines Bursaries in Geology -- To be awarded to full- time students with financial need, entering Brandon University and registered in 6 credit hours of first year Geology. Preference will be given to Aboriginal students ...... 3 x $1,000 7

James of Goodlands Bursaries -- Awarded to Senior 4 students on the basis of both financial need and satisfactory high school standing entering from Western Manitoba in any program ...... 4 x 500

Scotiabank Scholarship for Aboriginal students in financial need - to be awarded to an Aboriginal student who demonstrates financial need and satisfactory performance. The recipient must be registered full- time in any degree program at Brandon University. Preference will be given to a student in Business Administration...... $1081

Jack Spalding Family Bursary in Music - to be awarded to a student in the School of Music who demonstrates financial need...... $890

Dr. Donald & Mrs. Sandra Penny Bursary in Business Administration -- to be awarded to a student from rural Manitoba with financial need, who is entering the Business Administration or equivalent program at Brandon University ...... $1583

The Muir Family Bursary -- awarded to a student entering first year at Brandon University who has academic merit and a financial need. If no suitable student is available, then the bursary will be awarded to a continuing student...... $460

Brandon University Students’ Union Endowed Bursaries -- will be granted to full-time or part-time students in financial need. The number of awards will vary as the endowment grows. Endowed awards will be $500 each. The awards will be proportionally allocated based on the most recent available student enrolment figures for each area of the University...... # TBA $500

Dr. Doreen (Rowse) Pachal Bursary -- To be awarded to an entering student on the basis of financial need and academic merit, who is attending Brandon University from a province outside of Manitoba. Award may not be shared...... $636

Brockie-Donovan Bursary -- offered on basis of high school marks and financial need...... $500

Manitoba Blue Cross Bursary for Students with Special Needs -- awarded to students entering any program who must incur additional expense to attend University due to a physical or other handicap. (Please provide letter explaining details of your handicap.) ...... $TBA

Manitoba Blue Cross Entrance Bursary -- awarded to a Senior 4 student on the basis of both a financial need and a high overall academic standing entering any program at Brandon University...... $TBA

Manitoba Blue Cross Traveller’s Bursary -- awarded to a Senior 4 student on the basis of financial need and high academic standing from rural Manitoba who must travel more than l00 kilometers (one way) to attend the University as a full-time student...... $TBA

Dr. Kevin and Mrs. Els Kavanagh Entrance Bursary -- to be awarded to an outstanding student in financial need who is entering Brandon University ...... $2106

Miss Cecil Essadelle Rombough Bursary -- provided from the estate of Miss Rombough for students who enter Brandon University from a Winnipeg high school...... $670

Dr. Jack Norman Edmison Memorial Bursary - To be awarded to a deserving entering student from Brandon or rural Manitoba with financial need ...... $1233

Al and Bee Wagner Bursary in Music - to be awarded on the recommendation of the School of Music Scholarship Committee to an entering or continuing student on the basis of financial need ...... $2925

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J.R.C. Evans Masonic Bursary - awarded on the basis of high school marks and financial need ...... $405

Press Radio Entrance Bursaries -- awarded on the basis of high school marks and financial need...... 5 x $500

Brandon University Students’ Union Bursary -- awarded on basis of high school marks and financial need...... $250

Milton C. Holden Memorial Bursaries -- funds to be provided by the Milton Holden Memorial Fund through the Brandon Area Foundation for deserving students with scholastic promise in financial need who are entering or returning students at B. U. To be eligible the student must register in l8 credit hours or more...... … $1000

Manitoba Women’s Institute Frances I. McKay Bursary -- awarded to a Manitoba student entering first year Science ...... $TBA

Canadian Federation of University Women, Brandon Branch, Bursary -- awarded to a female student with preference in the following order: a) a mature student who has not attended either a Secondary school or a Post secondary institution for at least one year; b) a regular student who is applying when over the age of twenty-one and has not attended either a secondary school or a Post secondary institution for at least one year; c) a student who has completed at least one year of University and has not attended either a secondary school or a post secondary institution for at least one year; d) a regular student who is applying when twenty-one years of age or younger and has not attended a secondary school or a post secondary institution for at least one year; and e) a student who has received the bursary in a prior year and who is continuing with her studies ...... 3 x $500

Royal Oak Inn and Suites Scholarship/Bursary -- to be awarded to an employee of The Royal Oak Inn and Suites, or to an immediate family member of an employee (who would include mother, father, brother, sister or spouse) who is planning to attend Brandon University on a full-time basis in the program of their choice. Applicants will provide a letter of proof of employment from the Royal Oak Inn and Suites, which shows the number of years of employment status. In the event there is more than one applicant applying, preference will be given to the applicant with the most number of years of service with The Royal Oak Inn and Suites, and then to immediate family of employees, and lastly to the applicants with the most financial need...... $481

Victoria Inn Hotel and Convention Centre Scholarship/Bursary -- to be awarded to an employee of the Victoria Inn Hotel and Convention Centre (Brandon) or to an immediate family member of an employee (who would include mother, father, brother, sister or spouse) who is planning to attend Brandon University on a full-time basis in the program of their choice. Applicants will provide a letter of proof of employment from the Victoria Inn Hotel and Convention Centre, which shows the number of years of employment status. In the event there is more than one applicant applying, preference will be given to the applicant with the most number of years of service with the Victoria Inn Hotel and Convention Centre, and then to immediate family of employees, and lastly to the applicant with the most financial need...... $957

Breneman Family Scholarship/Bursary - to be awarded to a student from rural western Manitoba entering his/her first or a subsequent year at Brandon University, who has achieved a minimum cumulative grade point average of 3.0 (or an equivalent high school average) and who has demonstrated financial need. A letter of recommendation indicating community service is also required...... $2561

Connor, Clark and Lunn Financial Group Bursary in Music -- to be awarded to an entering or returning student in the School of Music on the basis of financial need. This award may be shared between two or more students ...... $2001

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The Long and McQuade Scholarship in Music -- to be awarded to an entering or returning student in the School of Music. Preference will be given to promising instrumentalists...... $TBA

Mary Cunningham (Babuik) Memorial Scholarship -- To be awarded to an entering student on the basis of academic proficiency, demonstrated leadership ability and financial need. Two letters of reference attesting to the student’s leadership ability must support the application (Not to be shared) .... $TBA 10

TO BE COMPLETED BY ALL APPLICANTS (PLEASE PRINT)

Personal Information:

Student Number Last Name First Name and Initial Street/Address City Province Postal Code Telephone Number: Home Work e-mail: Sex (M/F) Birth Date (D/M/Y) Marital Status: Single Married Common-Law Divorced Other Citizenship: Canadian ______Permanent Resident ______Other ______Parents/Next of Kin (do not include spouse or children) Relationship Last Name First Name and Initial Street/Address City Province Postal Code Telephone Number: Home Work Spouse’s Personal Data (if applicable) SIN # ______Last Name First Name and Initial High School Information: High School Graduate (Y/N) Date of Graduation Name of High School Academic Data: Name of Degree Program Applied for Number of Credit Hours Registered For Name of Major or Specialization After graduation from Brandon University, do you plan to continue your studies in Medicine, Veterinary Medicine, Optometry, etc? Please list: ______Previous post-secondary education: Institutions and dates: ______

Financial Need Information (To be completed by all students applying for bursaries.)

In defining financial need, we are required to follow certain general principles as specified by the Province of Manitoba, as the Province provides a portion of the funding for many awards. First priority will be given to students who will be receiving Manitoba Student Financial Aid (a student loan) as per item number 1, below. For any particular award, if there are no applicants who qualify under item number 1, consideration may be given to applicants who can truthfully attest that item number 2 applies to them.

1. I will be receiving a student loan through Manitoba Student Financial Aid and will provide the Scholarship Office with a copy of the Notification of Award by September 17, 2012. Signature of applicant.______Note: Please write your Brandon University student number on the copy of the Notification of Award given to the Scholarship Office 11

2. I have not applied for a student loan through Manitoba Student Financial Aid, but I have a financial need and the receipt of a bursary would allow me to reduce my hours of part-time work in order to better concentrate on my studies. Signature of Applicant. ______

Please complete your budget, including parent/spouse income sections that follow if you have not applied for a student loan:

BUDGET FOR THE ACADEMIC TERM (September 1 – April 30) Expenses Total $ Resources Total $ Tuition Parents’ Contribution Books & Equipment Spouse’s Income Rent RESP Telephone Savings Heat/Electricity Scholarships/Bursaries Food Clothing Provincial Bursary/Grant Transportation costs Entertainment Government Income Other (Please specify) (eg. Canada Child Tax Benefit) Income Tax Rebate expected Other Income (Please specify) TOTAL TOTAL

Deficit (Total expenses – Total Resources) = Required $ ______

Declaration:

I declare that: • all information given on this application is complete and true in every respect; • I have answered all questions applicable to me on this form; • I shall be a student for the academic period and the course load stated; • I will notify the Scholarship Office in writing, of any changes in my address or telephone number.

My Signature Date

PLEASE RETURN FORM TO: Ms Janet Olmstead Wood Senate Scholarship Office, Room 119, McKenzie Building Brandon University 270 – 18th Street Brandon MB R7A 6A9 (204) 727-9737 or e-mail: [email protected]

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Brandon University collects the personal information on this form pursuant to the Brandon University Act and The Freedom of Information and Protection of Privacy Act. The information you provide on this form is used for purposes of determining eligibility for awards. It may also be used for research purposes, but, in those cases, individual identities will not be disclosed.

The names of award recipients may be publicly recognized and made available to the corresponding donors.

Any questions or concerns regarding the release of this information can be directed to Janet Olmstead Wood at 727- 9737.

Signature Date

OR:

If you do not wish your name and award to be publicly recognized, please complete and sign the statement below.

I, ______, ask that my name and award not be publicly released.