Printable Form

The Thomas Washburn Memorial Scholarship
APPLICATION FORM

 

Applicant's Name: ________________________________________________________________________

Address: ________________________________________________________________________________

________________________________________________________________________________________

Phone No. _____________________     E-mail address   _________________________________________

High School ___________________________________________ Graduation Year __________________

Names, occupations and phone numbers of two people who will provide character references:

1. ____________________________________________________________________________________

2. ____________________________________________________________________________________

Universities and faculties to which you have applied for admittance:

University 1. 2. 3.
Faculty      

Volunteer Activities. "Contribution" may be hours spent per term, period involved, achievements, responsibilities, etc.

    School Community
Athletics Activity
Contribution
   
Activity
Contribution
   
The Arts Activity
Contribution
   
Activity
Contribution
   
Other Interests Activity
Contribution
   
Activity
Contribution
   

"Contribution" may be hours spent, period involved, achievements, responsibilities, etc, for each activity.

If you need more space for ANY category you can use a separate page
OR download the printable (rtf) version and create more rows/lines as necessary.

Other relevant information: ________________________________________________________________

NOTE:     An application for The Thomas Washburn Memorial Scholarship must include, but is not limited to, the following:

  1. A completed application form.
  2. Letters of reference from the two character referees named above.
  3. A short essay (one page is adequate) which should include educational and career goals, why the applicant qualifies for this scholarship including non-academic attributes, and what receipt of it would mean to him or her.
  4. A transcript of the applicant's high school marks.

On or before March 31 the application package must be mailed (postmarked on or before March 31) or
delivered to Dr. Owen and Sheila Washburn, 181 Ross Terrace, Fredericton, NB E3A 8E5, Phone 472-3842.

For more information see www.washburn.ca/thom