Margaret Stokes Chapter
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IODE Margaret Stokes Chapter Education Award Application

Please copy this form and submit it to the Student Services Department of Lambton Central Collegiate & Vocational Institute.  Awards will be given out at the L.C.C.V.I. Awards Night/Graduation in the fall.  Students who demonstrate a financial need are given preference for this award.

(Replies are Confidential)

1.         Applicant’s Name:  ___________________           _____________________________________

                                                  Surname                                 Given Names

2.         Home Address:  __________________________________________________________           

            Telephone:  _________________________         S.I.N. __________________________

3.         Date of Birth:  _______________________            Place:  __________________________

4.         Proposed Post-Secondary Training Institution:  __________________________________

                                               Course:  _____________________________________________

5.         Career Goal:  ____________________________________________________________

6.         Other bursaries, scholarships other financial assistance you will be receiving:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

              OSAP: Y___     N____     Amount:    _________________________________________

7.         a) Parents’ total income from all sources for the year ending December last:  _________

             b) Parents’ taxable income:  ____________________

              c) Father’s Occupation:  ____________________________________________________

                    Employer:  ____________________________________________________________

               d) Mother’s Occupation:  ___________________________________________________

                     Employer:  ____________________________________________________________

8.         Statement of your own financial resources: 
____________________________________________________________ ____________________

__________________________________________________________________________________

______________________________________________________________________________________

                                                                                                    

9.         Siblings:

Name                                                    Age                              Present Situation

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

10.        Special Factors:  List special factors to be considered, e.g. other  persons living at home, special expenses of any kind,
            siblings attending other institutions etc.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

11.        Other items:

a) Extra-curricular activities while at LCCVI:

____________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

b) Activities/Hobbies outside school:  __________________________________________

________________________________________________________________________

________________________________________________________________________

c) Summer or Part-time jobs held (last 2-3 years):  ______________________________

________________________________________________________________________

________________________________________________________________________

DECLARATION:

The undersigned hereby declares that the information given in this application is true in all respects:

Date:  __________________________      ____________________________________________

                                                                                  Applicant’s signature


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