Rus Rice Memorial Bursary Application

Applicant:

First Name

Last Name

Address

City

Province/State

Postal/Zip Code

Phone Number

Parent(s)/Guardian First Name

Parent(s)/Guardian Last Name

Address

City

Province/State

Postal Code

Home Phone Number

Business Phone Number

Fax Number

Insurance Firm (Parent/Guardian) associated with

University Attended Last Academic Year (if applicable)

Studies Completed - Year/Faculty

University to be attended next Academic Year

Please provide a short profile of your chosen field of studies and career objectives

Special Studies completed/work experience

Outside interest/organization/offices held-since last year in high school

From summer employment (total earnings)

From scholarships received or expected

From bursaries received or expected

From Canada Student Loan & Government Bursary Programs

From other sources (parents, relatives, etc.)

TOTAL of above resources

Fathers Name

Father's Occupation

Mothers Name

Mother's Occupation

Name and Ages of other dependants in household

Names and addresses of two individuals that may be contacted as references. Both references must be from Academic sources familiar with your studies.

Office use only: