SRC Scholarship & Bursary Application

Please tell us about yourself...

The purpose of this page is to obtain your personal information for the scholarship and bursary application. After all, if we don't know who you are we can't give you the scholarship, can we?

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* 1. What is your full name?

First

Middle (optional)

Surname

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* 2. What is your pernament home address?

Street/Box #

City/Town

Province

Postal Code

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* 3. What is your phone number?

Home

Cell

Other

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* 4. What is your e-mail address?

Primary e-mail

Other e-mail

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* 5. What is your birthdate?

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* 6. What is your Social Insurance Number (this is optional at this point, but will be required if you are selected)

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* 7. Which one are you?

Male

Female

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* 8. What is your marital status?

Single

Married

Common-law (you have a partner you are not married to, but he/she has been living with you for at least 12 months, is the parent of your child by birth or adoption, or has custody or control of your child)

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* 9. What is your student status?

Dependent (Single, no kids AND out of high school for less than 4 years AND living with your parents/guardians)

Independent (married/common-law OR have been out of high school for 4+ years OR living on your own OR are working full-time for two years after high school graduation)