Iris Pollock Memorial Scolarship

Application

Signature Support Services Society provides annually a $500.00 scholarship in memory of Mrs. Iris Pollock. For over a decade, Mrs. Pollock served in capacities of volunteer, teacher and Principal in education programs in Grande Prairie.

The scholarship will be payable to any University or College student or person entering into a field of study that relates to persons with barriers, and who intends to work in this field in Northwest Alberta upon graduating.

The scholarship shall be awarded on the basis of scholastic achievement, citizenship and demonstrated interest in persons with barriers. Funds shall be provided to the successful recipient in one installment by December 15th. None of the scholarship shall be repayable by the recipient.

The application, with official copies of transcripts of all high school, university and related course marks, should be submitted no later than November 15th of the current year

Section A: Personal Information

Name:

Email Address:

Date of Birth:

Permanent Address

Apartment Address:

Street Address:

Street Name:

City:

Province:

Postal Code:

Phone Number:

I have continuously resided in Northern Alberta since:

Month:

Year:

Alternate Contact Address:

Apartment Address:

Street Address:

Street Name:

City:

Province:

Postal Code:

Phone Number:

Section B: Educational Information

Current Education:

Program Of Enrollment:

Major:

Institution:

Last Year You Attended High School:

Education History:

Education: List high school(s) and post secondary institution(s) attended. Begin with most recent.

Name Of Institution:

Year Attended:

Name Of Institution:

Year Attended:

Name Of Institution:

Year Attended:

Section C: University/College Record

(Include a transcript of present, first or second year grades as well as details of your future post secondary educational degree or diploma)

Attach Transcript (PDF files only)

Section D: Career Goals and Activities

Career Goals:

Clubs and Organizations:

Describe any involvement you have in the college, high school and/or community clubs or organizations.

Clubs and Organizations:

Section E: Other Related Courses

(List any courses, certificates, etc. that you may have attained in relation to Human Services, etc.)

Other Related Courses:

Comments:

Comments

This Application Must Be Signed

I hereby certify that the information given on this application is complete and true in all aspects. I authorize the Financial Aid Office to access my academic and financial records and to release pertinent information to the donor of the award and provincial funding bodies. I understand that the decisions made by the selection committee are final.

Please Enter Your Name:

Initials Of Applicant:

In the Province Of:

Date:

Iris Pollock Memorial Scolarship

Application

Permanent Address

I have continuously resided in Northern Alberta since:

Alternate Contact Address:

Current Education:

Education History:

Thank you for your application. Successful applicants will be contacted by Signature Support Services Administration.

Main Office & General Inquiries: