Kinsmen Club of Stony Plain Bursary Application Form

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First Name:

Middle Initial:

Last Name:

Address:

Address Line 2:

City/Town:

Province:

Postal Code:

Cell Phone Number:

Name of Institution:

Program:

Start Date:

Year

Month

Day

Completion Date:

Year

Month

Day

Credentials Expected (diploma, certificate, etc.):

Which year of your program will you be entering?

Estimated expenses for the year?

Extra-curricular Activities:

Community Service & Volunteer Activities:

Work Experience:

Briefly outline your plans for your future career and how this bursary would assist you.

Please comment on your knowledge or experience with Kin Canada or the Kinsmen Cub of Stony Plain.

List any additional information which you feel is important for consideration by the committee.

Today's Date:

I hereby certify the above information is correct and can be verified on request, and that I have not been a recipient of this bursary previously.

I agree.