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
(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
