Village of Pemberton Bursary About the Village of Pemberton Bursary The Village of Pemberton Bursary is a financial award of $3000, which recognizes students who demonstrate outstanding citizenship, leadership, volunteerism and who intend to pursue post secondary education. Personal Information you provide on this form is collected under section 26 of the Freedom of Information and Protection of Privacy Act and will be used only for the purpose of responding to your bursary application. Your personal information will not be released except in accordance with the Freedom of Information and Protection of Privacy Act. Questions about the collection of your personal information may be referred to the Manager of Corporate & Legislative Services. Personal Information First Name * Last Name * Email * Phone Number * Street Address/Mailing Address * Town * Province * Postal Code * School Name: * Graduation Date: * Student ID Number: * How did you hear about the Village of Pemberton bursary? * Village of Pemberton Facebook Page www.pemberton.ca Teacher/instructor Family/Friends Academic Awards Please indicate any awards you have received for academic standing (including any post-secondary scholarships awarded) School Activity Participation Please list and describe your school related activities and participation. Be specific and provide dates. Organizations/Activities/Sports Leadership Positions Awards/Recognition Extracurricular Activities & Participation Please list and describe your extracurricular activities and participation in the community, including any volunteer work, sports teams, art and music activities etc. Please be specific and indicate if the activity is a one-time experience or an on-going commitment. Organizations/Activities/Sports Leadership Positions * Awards/Recognition Post-Secondary Plans Which post-secondary institution do you wish to attend? * When do you expect to commence your full-time studies? * Have you applied for admission? * Yes No Have you been accepted? * Yes No Please attach academic transcripts for Grades 11 and 12 * Choose File No file chosen The maximum total size of all files in a single form submission is 1 GB. Please attach a cover letter detailing your career goals * Choose File No file chosen The maximum total size of all files in a single form submission is 1 GB. Please attach two letters of reference attesting to the character of the applicant and providing reasons to support the applicant's consideration (from coach, teacher, instructor, supervisor, employer, community group leader etc). Letter of Reference 1 * Choose File No file chosen The maximum total size of all files in a single form submission is 1 GB. Letter of Reference 2 * Choose File No file chosen The maximum total size of all files in a single form submission is 1 GB. Leave Blank