1.Full Name

2.Email Address

3.Province of Residence

British ColumbiaAlbertaSaskatchewanManitobaOntarioQuebecNewfoundland & LabradorNova ScotiaNew BrunswickPrince Edward IslandYukon TerritoriesNorthwest TerritoriesNunavut

4.Name of post secondary institution

5.Program of study

6.Year of study (Fall 2026)

First yearSecond yearThird yearFourth yearGraduate program

7.Neuromuscular diagnosis

8.Why did you choose your program of study and what are your goals for the future? (Maximum 250 words)

9.What is one barrier you face while pursuing post-secondary education as a student living with a neuromuscular disorder, and how could this bursary help address it? This could relate to accessibility, health needs, transportation, fatigue, financial costs, assistive technology, personal care, or other challenges.(Maximum 200 words)

10.Have you been involved in any community activities, volunteer work, advocacy, or leadership that are meaningful to you? (Maximum 150 words)

11.How would you intend to use this bursary to support your education?

12.Is there anything else you would like the selection committee to know about you? (Maximum 150 words)