Kennebecasis Valley Chamber of Commerce

Scholarship Application Form

Please print

Student Name:   _______________________________________________________________________

                              Last                                         First                                  Middle             (Preferred to be called)

Mailing Address: ______________________________________________________________________

Street Address:  _______________________________________________________________________

Town: _________________________________________________,   N.B    Postal Code _____________

Telephone No. _____________________  Email address:  _____________________________________

High School:          £   Kennebecasis Valley High School                            £   Rothesay High School

Please write a 250-500 word personal statement or an essay in answer to the question:
“Why do you believe you should be the recipient of this award?”

List any clubs, community activities, volunteer work, etc., in which you participate and any awards or
honours you have received.  If necessary, attach a separate sheet to complete.

Kennebecasis Valley Chamber of Commerce Scholarship Agreement

All information on these applications forms is true and complete to the best of my knowledge.  I understand that I may be
asked to provide proof of information stated on these forms. I agree to be bound by all the terms and conditions of the
 Kennebecasis Valley Chamber of Commerce Scholarship Program should I be selected as a recipient.

Name of applicant (Printed): __________________________________________________________

Signature of applicant:           _____________________________________  Date:  _______________

Name of parent (Printed):     __________________________________________________________

Signature of parent:                ______________________________________ Date:  ______________

 
Personal Information Release

I hereby give permission for the Kennebecasis Valley Chamber of Commerce to quote, publish and exhibit in brochures,
 on the KVCC website, and/or other materials including my name and photo for the purpose of promoting the Chamber’s
  Scholarship Awards.

Name of applicant (Printed): __________________________________________________________

Signature of applicant:           _____________________________________  Date:  _______________

Name of parent (Printed):     __________________________________________________________

Signature of parent:                ______________________________________ Date:  ______________

Please ensure that you application for the KVCC Scholarship Award is complete and all documents are submitted:

Checklist:

£  A 250-500 word personal statement or an essay in answer to the question:
“Why do you believe you should be the recipient of this award?”

£  Submit a reference letter regarding involvement in activities within school, community or employment,

£  Official Transcript of Marks

£  The “Scholarship Application Form”

£  The “Scholarship Agreement Form”

£  The “Personal Information Release Form”