Scholarship Application

Scholarship Application
Personal Information:
Alberta Student Number
Social Insurance Number
Name

First Name & Initial (Current Full Legal Name)Last Name (Current Full Legal Name)
Mailing Address
City/Town
Province
Postal Code
Phone Number
Email
example@example.com
Birthdate:

MonthDayYear
Date
Blue Mountain Power Co-op Membership:
Are either of your parents, or legal guardian, a member in good standing of Blue Mountain Power Co-op?

YesNo
Name of Parent / Legal Guardian (Member)
Account Number
Citzenship:

Canadian CitizenPermanent Resident (Landed Immigrant)
Note: Landed immigrants must include a photocopy of their immigration form, Visa students are not eligible
Do your parents currently live in Alberta?

YesNo
Did your parents live in Alberta while you were in high school?

YesNo
Proposed Post-Secondary Studies:
Name of Institution
Name of Program
Entry Date for Program

MonthDayYear
Date
Secondary Education:
Name of High School
Town/City
Province
Date of Completion of High School

MonthDayYear
Date
Additional Documents (Please see Eligibility Requirements on website)

Cancelof
Declaration of Applicant:
- I have read and understand the instructions, and declare that:
- All information provided is true and complete, and I understand it is subject to audit;
- I will be a student at the institution named for the period; and
- I will immediately notify Blue Mountain Power Co-op in writing if I withdraw from studies before completing one semester of studies.
I understand that if I receive a scholarship, I, or a member of my immediate family, will have the option to attend the next Blue Mountain Power Co-op Annual General Meeting to express a public thank you to the Membership and the Board of Directors.

I authorize Blue Mountain Power Co-op to release my name and program of study if I receive a scholarship.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Scholarship Application

Personal Information:

Blue Mountain Power Co-op Membership:

Proposed Post-Secondary Studies:

Secondary Education: