External Scholarship nomination form (for those needing) school approval

Student First Name *

Student Last Name *

Name of Scholarship (i.e. Loran, Schulich, etc.) *

PEN *

Father's (Guardian #1) name *

Father's (Guardian #1) occupation *

Mother's (Guardian #2) name *

Mother's (Guardian #2) occupation *

Briefly describe specific characteristics, talents, etc. that you wish the reference letter (or this application) to emphasize. *

1st Choice Post-Secondary and program *

2nd Choice Post-Secondary and program *

After post-secondary study, what profession or employment *

Grade 11 courses and percent *

Grade 12 courses and current percent *

List academic achievements and school awards – be specific as to the grade each was awarded. *

List any school extracurricular achievements and participation (sports, music, drama, service). *

List community achievements, participation, and volunteer work. *

Other hobbies, interests, or additional information you consider pertinent. *

Brief job history – position, role, or duties; indicating length of time at each job and the years involved. *

Leave this field blank

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