NAME: _______________________________

ADDRESS: _________________________________________________ POSTAL CODE __________

SCHOOL ATTENDED THIS YEAR: ___________________________GRADE OR YEAR: ________

PART TIME STUDENT _________ FULL TIME STUDENT _______________

WHAT COURSE DO YOU PLAN TO FOLLOW IN YOUR FURTHER TRAINING?

_____________________________________________________________________

DO YOU HOLD A DEGREE? ______ IF YES, WHAT? _____________________________________

TO WHAT PARISH DO YOU BELONG? ________________________________________________________

DO YOU HAVE A CLOSE RELATIVE WHO IS A MEMBER OF THE KNIGHTS OF COLUMBUS? ____________ WHO? ______________________________ COUNCIL NO. ____________

OPTIONAL: Selection is sometimes based on need. Attach a letter to describe your situation. Include a list of parish and community activities that you have participated in during this year.

1. Applications must be made through the Financial Secretary, Knights of Columbus, Box 426, Nanaimo, B.C., V9R 5L3.
2. Completed official applications must be in the hands of the Financial Secretary not later than June 30, 2012.
3. A copy of transcript of your last full school year’s work must accompany application form. This might include first semester marks or last year’s transcript. No application will be considered unless transcripts are provided. If you are not including a transcript, the committee will not look at your application. NO EXCEPTIONS!!!! 
4. Priority will be given first to sons and daughters of members of the K. of C. councils; second to catholic students with the councils’ parishes.
5. Priority is given to those students who are working towards their first bachelor’s degree or first post secondary certificate. If you already have a degree or are making a career change you MUST enclose a letter indicating why you think the committee should consider your application.
6. Students attending senior secondary school this school year are not eligible for this scholarship. These students must apply through their secondary school’s awards committee.

______________        _________________________           __________________

            Date                                 Signature                                     Phone Number

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