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2026 ALS Canada Kevin Daly Bursary Application Form

1.First Name:(Required.)
2.Last Name:(Required.)
3.Date of birth:(Required.)
4.Age:(Required.)
5.Address (street number, name, city/town, province, and postal code):(Required.)
6.Phone number:(Required.)
7.Email:(Required.)
8.Name of parent/guardian/family member affected by ALS:(Required.)
9.Name of post secondary institution:(Required.)
10.Year of admission:(Required.)
11.Program of study:(Required.)
12.How long is the anticipated course/program duration?(Required.)
13.Course description (Trades/Diploma/Degree):(Required.)
Please note the decision review committee reads every application very thoroughly and uses a scoring tool to determine recipients of the bursary. Please provide as much detail as possible within the word limit noted for each question.
14.Please describe the area of study that you have chosen to pursue and why it is important to you. (250 word limit)(Required.)
15.Considering your experience as someone who has been impacted by ALS, please explain how this has affected you. Provide examples illustrating the challenges that you have faced and how they have influenced your growth. (750 word limit)(Required.)
16.Caregiving is a very important aspect of the ALS journey. Please share your role in caregiving and/or your experience with the caregivers of your loved one. (500 word limit)
17.Please describe your involvement in activities such as awareness campaigns, fundraisers, or support groups, highlighting any leadership roles or initiatives you have taken within your community. How do you plan on pursuing these in the future? (250-word limit)(Required.)
Note: All potential candidates will be required to join a virtual video call with the committee who will be choosing the recipient.

By submitting your application, you agree that the information included is true. In addition, you agree to have your story and name shared through ALS Canada’s media channels.

Should you have any technical issues submitting this form please reach out to legacy@als.ca and someone will be in touch to help troubleshoot.