ADHS GRAD AWARDS – GENERAL APPLICATIONRETURN THIS COMPLETED 4 PAGE FORM DIRECTLY TO MRS. ZIMMERLING OR A GUIDANCE

COUNSELLOR. (DO NOT LEAVE IT ON THE DESK!)

NOTES:1. All awards must be applied for, regardless of the conditions. Failure to apply for an award

may remove you from the eligibility list for that award.2. Special Application Forms must be handed in at the same time as the general application

form.3. Enter your name for each award that you are applying for on the individual awards

application page in the awards application binder in Student Services.4. Deadline date: Tuesday, April 21 st by 12 noon 5. For students applying for the Ontario Power Generation Award, please attach a small photo.

APPLICANT INFORMATIONNAME:_______________________________________________SIN # (req.): _____________________________

(Surname) (Given Names)CURRENT MAILING ADDRESS: _________________________________________________________________

Name of institution you plan to attend next year: _____________________________________________________

Name of course/program you are applying for: _______________________________________________________

Career you wish to follow: _______________________________________________________________________

I agree to notify Student Services of any changes in the above information and I agree to have my name passed on to the Arnprior Hospital if I am pursuing a post-secondary education in the medical field.

Signature: ____________________________________________________________

AWARDS APPLIED FOR (use full name of award).

if Special Application Form is included.

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________(attach a separate sheet, if necessary)

….2

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ACTIVITIES AND EXPERIENCEA number of the awards are not based solely on academic standing, but also include participation in:

Work experiences Extra-curricular activities in school (clubs, teams, music, etc.), Activities in the community (4H, church, etc.), Volunteer hours

To assist the Awards Selection Committee, please describe, in the following three sections, any of these activities that you are, or have been, associated with. Attach additional information, if necessary.

1. Work Experience List any jobs you have had since you started high school. Attach additional information, if necessary.

Location Job Title From(mm/yy)

To(mm/yy)

Approx. # ofhours/week Job Duties

…3

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2. Extracurricular Activities (school and community)

Describe your extracurricular activities since you started high school – both in school and the community

School: (examples: sports, clubs, music, student government etc.)

Activity Grade(s) How often? Role/Position & Responsibilities

Community: (examples: 4H, church, sports, clubs, dance, music etc.)

Activity Grade(s) How often? Role/Position & Responsibilities

….4

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3. Volunteer Hours 40 Volunteer Hours completed. List where and what you have done for your 40 volunteer hours.

Location Duties Grade(s) # ofhours

Beyond 40 hours completed. If you have done more than 40 hours, list where and what you have done beyond the 40 hours. Attach additional information, if necessary.

Location Duties Grade(s) # ofhours

ARNPRIOR DISTRICT HIGH SCHOOLAPPLICATION FOR VALEDICTORIAN

Name: ___________________________________________

Current Year’s Program (List Courses)

Semester 1 _________________________________________________

Semester 2 _________________________________________________

Plans for Next Year

Contribution to Student Life at ADHSExplain how you have represented everyone in the graduating class of 2015.

For Office Use Only

Student’s Semester 1 Marks

Student’s Semester 2 Marks

ARNPRIOR & DISTRICT FISH & GAME CLUB:DON PIERCE and JEFFREY DRAPER MEMORIAL AWARDS

SPECIAL APPLICATION FORM

NAME: ________________________________________________________________________

Evidence of your active community service:

Write a 300+ word essay depicting a unique or humorous outdoor experience (attach pages if necessary):

ARNPRIOR COMMUNITY SAFETY PARTNERSHIP COMMITTEE AWARDS

SPECIAL APPLICATION FORM

NAME:_________________________________________________________________________

ADDRESS:_____________________________________________________________________

NAME OF POST-SECONDARY INSTITUTION:_________________________________________

NAME OF POST-SECONDARY PROGRAM:___________________________________________

COMMUNITY:

We are looking for a student who not only has good marks, but someone who is involved in their community. Please indicate what you have done in your community over the last four years. You can include any extra-curricular activities at your high school or outside of school.

Due to the fact that we don’t have the opportunity to meet all the applicants personally, here is your chance to let us know why you think you deserve this bursary. In about 100 words, tell us why you decided on law enforcement as your career choice and how you think you could use your authority to improve the world today.

ARNPRIOR REGIONAL HEALTH AUXILIARY BURSARIESFOR ALLIED HEALTH and NURSING

(please circle one)

NAME:______________________________________________________________________

NAME OF POST-SECONDARY INSTITUTION:______________________________________

NAME OF PROGRAM:_________________________________________________________

CAREER PLAN:_______________________________________________________________

Attach an extra sheet if more space is required.

Please outline where you have volunteered and how many hours you have done in the community.

List the extra-curricular activities, and their duration, that you have participated in, both in school and in the community.

What leadership roles have you experienced?

Have you done a co-op placement in the healthcare field? If so, where?Please describe your experience.

CHRISTIAN EDUCATION AWARD

SPECIAL APPLICATION FORM

NAME:_________________________________________________________________________

NAME OF POST-SECONDARY INSTITUTION (for further training in the Christian Education

Field):_________________________________________________________________________

List or describe ways in which you have been actively involved in Christian activities in church, school and/or community.

Grade 12 average:_______________________________________________________________

Reasons for financial need (if applicable).

GLOBAL AWARENESS AWARD

SPECIAL APPLICATION FORM

NAME:_________________________________________________________________________

ACADEMIC MARKS:

1. English 4U _____________and/or

2. French 4U _____________and/or

a. Grade 12 History or Geography emphasizing other cultures or awareness of the world as a whole:

__________________________________ ___________________________________

__________________________________ ___________________________________

A. List your READING, outside the school curriculum, of world literature and/or works of non-fiction dealing with the climate crises and cultural diversity. (may include journals, some magazines)

B. Reflections on the climate crises.

C. Reflections on cultural diversity in relation to the human experience.

D. Practical Involvement related to the challenge of the climate crises or cultural diversity.

GLOVER DENTAL TEAM WELLNESS AWARD

SPECIAL APPLICATION FORM

NAME:______________________________________________________________________

NAME OF POST-SECONDARY INSTITUTION:______________________________________

NAME OF PROGRAM:_________________________________________________________

Outline how you meet the personal criteria of this award. (Conditions 1 and 2)Attach page(s) if needed.

Outline your plans for financing your education.

The HARRY and JANET CLANCY ENDOWMENT

SPECIAL APPLICATION FORM

NAME:______________________________________________________________________

ADDRESS: __________________________________________________________________

POST SECONDARY INSTITUTION: __________________________________________

POST SECONDARY PROGRAM: ____________________________________________

BEST SIX 4U MARKS (include first term final marks and list current courses)

COURSE MARK

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

________________________________________ _____________

AVERAGE = _____________

PROOF OF ACCEPTANCE (not just application) MUST BE ATTACHED!

The HELEN and BERT HALL AWARD

SPECIAL APPLICATION FORM

NAME:_______________________________________ SIN:______________________________

NAME OF COLLEGE:_____________________________________________________________

PROGRAM NAME:_______________________________________________________________

PART-TIME JOB/S – LIST PLACE/S

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

I recommend this student for this award based on the student displaying a good work ethic in my class.

Teacher Signature:____________________________________________________________

Teacher Name:_______________________________________________________________

J.J. NEILSON FAMILY ENDOWMENT FUND

SPECIAL APPLICATON FORM

(APPLICATION FOR STUDENTS ATTENDING ARNPRIOR DISTRICT HIGH SCHOOL)

NAME OF APPLICANT:__________________________________________________________

Address:________________________________________ Town:_________________________

Province:_______________ Postal code:______________ Phone:________________________

Birthdate of Applicant:_____________________________________________________________

Name of University you plan to attend next year:________________________________________

What University program will you be enrolled in next year?________________________________

PROOF OF ACCEPTANCE MUST BE ATTACHED

To assist the selection committee, please attach a letter indicating:

a. future career plans;

b. participation in co-curricular activities (in school, community, etc.); and

c. financial need.

Please return completed application by April 21, 2015 and all other requested information as quickly as possible to Student Services.

J.J. NEILSON FAMILY ENDOWMENT FUND

SPECIAL APPLICATION FORM

(APPLICATION FOR STUDENTS NOW IN UNIVERSITY)

NAME OF APPLICANT:___________________________________________________________

BIRTHDATE OF APPLICANT:___________________________ S.I.N.:_____________________

MAILING ADDRESS:_____________________________________________________________

PHONE NUMBER:_______________________________________________________________

NAME OF PARENT:______________________________________________________________

NAME OF UNIVERSITY YOU ARE ATTENDING:_______________________________________

UNIVERSITY COURSES COMPLETED: (PLEASE ATTACH TRANSCRIPT)

NAME OF UNIVERSITY YOU PLAN TO ATTEND NEXT YEAR:___________________________

WHAT UNIVERSITY PROGRAM WILL YOU BE ENROLLED IN NEXT YEAR?

______________________________________________________________________________(PROOF OF ACCEPTANCE MUST BE ATTACHED)

To assist the selection committee, please attach a letter indicating:

a. future career plans;

b. participation in co-curricular activities (in university, community, etc.); and

c. financial need.

Please return completed application and all other requested information by June 15 th to:

Head, Student Services DepartmentArnprior District High School59 Ottawa StreetArnprior, ON K7S 1X2

KATIE FRASER MEMORIAL AWARDSPECIAL APPLICATION FORM

NAME OF STUDENT:_____________________________________________________________

Write 300 words to tell how you have challenged stereotypes and blazed your own path to achieve goals. Be sure to tell how determination and attitude helped you achieve the goals.

KATRINA (KAY) LYMAN MEMORIAL AWARDSPECIAL APPLICATION FORM

NAME OF STUDENT:_____________________________________________________________

Write 300 words about the importance of family and where you see yourself heading in the future.

APPLICATION FOR ARNPRIOR KNIGHTS OF COLUMBUS AWARD

PART 1 (TO BE COMPLETED BY STUDENT)

Name:_________________________________________________________________________

Street:_________________________________________________________________________

Town:_________________________________ Telephone No.:______________ Age:________

College or University:_____________________________________________________________

Type of Course:__________________________________________________________________

Length of Course:________________________________________________________________

Signature:_____________________________________________ Date:____________________

PART 2 (TO BE COMPLETED BY PARENT)

Since the award is based in part on financial need, the following information is required (IN FULL). This information will be kept strictly confidential.

Father / Step-Father Mother / Step-Mother

Name:

Occupation:

Employer:

No. of Years:

Yearly Gross Income:

No. of dependent children (other than the applicant) in the family:___________________________

No. of other children at College or University:___________________________________________

Signature:________________________________________________ Date:_________________

LIEUTENANT GOVERNOR’S COMMUNITY VOLUNTEER AWARD

This application will be destroyed after the presentation of awards.

SPECIAL APPLICATION FORM

NAME:_________________________________________________________________________

List or describe ways in which you have contributed to the community or have been actively involved as a volunteer.(Attach extra pages if necessary)Volunteer Contribution to Community

If used as part of 40 hours

Dates / Length

Hours Description of responsibilities

LISA AMANDA AGNES ROESLER MEMORIAL AWARDSPECIAL APPLICATION FORM

NAME OF STUDENT:_____________________________________________________________

NAME OF POST SECONDARY INSTITUTION: ________________________________________

NAME OF PROGRAM: ___________________________________________________________

Describe in 300 words how your choices in life have positively impacted you and/or your community or how you have learned from your choices to make better decisions in the future.

SPECIAL APPLICATION FORM

AVAILABLE as .pdf

Open under separate tab.

ONTARIO POWER GENERATION

SECONDARY SCHOOL STUDENT ACHIEVEMENT AWARDSPECIAL APPLICATION FORM (5 PAGES)

NAME:_________________________________________________________________________

The applicant must have complete the OSSD and be proceeding to a post secondary institution.

1. Education Focus: circle one

Engineering/Electronics Science (not the health field)

Environment Mathematics Physics

Business Information Technology

State specific program title:_________________________________________________

2. Post secondary Institution:__________________________________________________

3. Grade 12 Average_________________________________________________________(minimum 75%)

4. High School Awards (list below)

Volunteer Work, Community Involvement, and Extra-curricular Activities:

Evidence of Leadership Skills:

Are you legally eligible to work in Canada? Yes No

_____________________________________________________ _______________________ Signature Date

Attachment 1ONTARIO POWER GENERATION

Secondary School Student Achievement Award (SSSAA) Award Criteria

Two annual awards per Ontario Secondary School in Ontario Power Generation (OPG) designated communities hosting our major plant / generating station sites.

$250.00 per award. Awarded to a student who has completed their Grade 12 with a specific focus on further College or

University study in any of the following fields: Engineering, Science, Trades and Technology (i.e. Electrical Engineering, Industrial Mechanical/Millwright, Power Engineering, Instrumentation Engineering), Mathematics, Physics, Environmental Studies or Business.

Requires strong oral and written communication skills. Demonstrated leadership skills. Is of good academic standing (minimum B average). Involved in extra-curricular activities and/or community volunteerism. Signed Consent & Release form from recipient(s) along with their graduation photograph must be

provided to the OPG representative below for use in OPG reports and community advertorials on the SSSAA.

Administrative Process The award candidate is nominated through the Secondary School internal awards selection

program. Following nomination, the School Awards Officer/School Board Representative provides a

completed Recipient Profile Sheet (attached) along with a signed consent and release form (also attached) to the OPG representative listed below. The OPG representative must receive this at least 3 weeks in advance of the graduation ceremony.

Ontario Power Generation will provide the designated School Boards (Public and Separate) with a cheque for the award winners in the qualifying Secondary Schools. School Boards will set up a Trust Fund and will re-issue the award cheques in each student’s name so that OPG may be charitably receipted for its support. The Secondary Schools will present the cheques according to their specific award/graduation processes.

Ontario Power Generation will arrange (where possible) for a company representative to be present at the graduation awards ceremony to present the OPG SSSAA to the successful candidates.

An Award Certificate of congratulations from OPG will also be provided to the students at the ceremony.

The School Board / School will issue charitable receipts to Ontario Power Generation for all student awards in each calendar year.

Please direct any correspondence and all receipts to:

Attn: Cindy ClarkeManager, Corporate Citizenship ProgramOntario Power Generation, 700 University Avenue, H19 E4Toronto, Ontario M5G 1X6Phone: (416) 592-8775Fax: (416) 592-8788Email: cindy.clarke@opg.com

Attachment 2

ONTARIO POWER GENERATION

SECONDARY SCHOOL STUDENT ACHIEVEMENT AWARD (SSSAA)

Recipient Profile Sheet

School Board: Renfrew County District School Board

School Name: Arnprior District High School

School Mailing Address: 59 Ottawa St., Arnprior, ON K7S 1X2

School Contact Person/Awards Officer: Phil Moore

E-Mail: moorep@rcdsb.on.ca

Telephone: (613) 623-3183 ext. 229

Fax: (613) 623-6973

Award Winner’s Name:________________________________________________________

Age (re: consent and release form):______________________________________________

Education Focus Area (i.e., Engineering, Science, Environment, Technology, Math and

Physics):____________________________________________________________________ Academic Standing:___________________________________________________________

Other Secondary School Awards:________________________________________________

Post-Secondary Institution (College/University):_____________________________________

Post-Secondary Study Program (Environmental Studies, Engineering, et al):_______________

___________________________________________________________________________

…2

Recipient Information

Secondary School

- 2 -

Other Interests:_______________________________________________________________

___________________________________________________________________________

Volunteerism/Community Involvement:____________________________________________

___________________________________________________________________________

Leadership Skills:_____________________________________________________________

___________________________________________________________________________

Date and Time: Thursday, June 25, 2015 at 4:00 p.m.

Address/Location Within School: McEwen Gym, ADHS, 59 Ottawa St., Arnprior

Required Time of Arrival for OPG Presenter:_______________________________________

School Contact: Jill Reid, (613) 623-3183 ext. 225, reidj@rcdsb.on.ca

Departure Time for OPG Presenter:_______________________________________________

Consent and release form completed by the award recipient and enclosed: Yes No

Graduation picture enclosed:Yes No

The School Contact/Awards Officer in consultation with the award recipient should complete this form. The completed forms should then be submitted along with the signed consent and release form and graduation photograph through the school awards process/School Board to the following OPG contact:

Cindy ClarkeManager, Corporate Citizenship Program

Ontario Power Generation700 University Avenue, H19 E4

Toronto, OntarioM5G 1X6

Telephone No.: (416) 592-8775Fax No.: (416) 592-8788

E-mail Address: cindy.clarke@opg.com

Should you have any questions concerning the form or process, please contact the above noted OPG representative.

Graduation Ceremony

Consent and Release I hereby consent to Ontario Power Generation Inc. its agents, successors and

assigns (collectively the "Corporation") using, storing, retrieving, duplicating or reproducing (i) my

name; (ii) photographs, artwork or writing provided by me; (iii) photographs, artwork or videos in

which I appear; and (iv) recordings made of my voice, in any media or territory, for purposes the

Corporation deems suitable.

I hereby waive and release the Corporation from and against any and all claims

which I or my successors have or may have, arising out of such use, storage, retrieval, duplication

or reproduction more fully described in the above paragraph, including but not being limited to

invasion of privacy, appropriation of personality, infringement of copyright or moral rights, or

defamation. I acknowledge that no remuneration will be paid to me at any time.

Organization (please print): Arnprior District High School

Individual (please print):

Project, Event or Award: High School Graduation Award, 2015

Address: 59 Ottawa Street, Arnprior, ON K7S 1X2

Signed: Date:

Witness: Date:

If under eighteen, parent or guardian must also sign.

Name (please print):

Address:

Signed: Date:

Witness: Date:

Please return this completed form to the Ontario Power Generation contact listed below: Name: Cindy Clarke Title: Manager, Corporate Citizenship Program, OPGAddress: 700 University Avenue, 19th Floor E4, Toronto ON M5G 1X6Telephone: (416) 592-8775 Fax: (416) 592-8788Email: cindy.clarke@opg.com

1PILON FAMILY CITIZENSHIP AWARDSPECIAL APPLICATION FORM

NAME OF STUDENT:_____________________________________________________________

NAME OF COLLEGE:_____________________________________________________________

NAME OF PROGRAM:____________________________________________________________

SERVICE TO SCHOOL AND COMMUNITY:List the activities you have participated in. Include your role and duration of involvement.

FINANCIAL NEED:Outline your plans for financing your education.

RENFREW COUNTY ROAD SUPERVISORS ASSOCIATION

SPECIAL APPLICATION FORM

NAME OF STUDENT: ____________________________________________________________

ADDRESS:_____________________________________________________________________

NAME OF COLLEGE/UNIVERSITY:_________________________________________________

NAME OF PROGRAM: ___________________________________________________________

PLEASE CHECK THE APPLICABLE COURSE OF STUDY YOU WILL FOLLOW:

Engineering – Civil Preferred (Degree or Diploma) Environmental Technician/Technologist Survey Technician/Technologist GIS/CAD Technician/Technologist Trades

o Heavy Equipment Operatoro Heavy Equipment Technician (Mechanic)o Truck/Coach Technician (Mechanic)

The Royal Canadian Legion Branch 174

POPPY BURSARY APPLICATION FORM

Conditions1. The applicant must have received the Ontario Secondary School

Diploma.2. The applicant must be proceeding or attending a Post Secondary

Education at a University or College.3. The recipient shall be chosen by The Royal Canadian Legion

Branch 174 Bursary Committee.

Value: $500.00

Poppy BursaryEligible to students who have immediate family (great grandfather\mother; grandfather\mother; father, mother, brother, sister) who are serving or have served in the Canadian Armed Forces.

Name of Immediate Family Member: _____________________________

Relationship: _____________________________________________

Applicants Status (check) Son or Daughter of: Legion Member Yes __ No ___ Membership Number: ____________

Applicants Information

Name: ___________________________________ Age: _________

Address: ________________________________ Town: ____________

Province: _____ Postal Code: __________ Phone: ___ - ___ - ____

Parents Name: __________________________ Phone: ___ - ___ - ____

1 of 2

Please check: University __________ College: ________

Name of Institution you plan on attending: ___________________________

Location: __________________

Type of course enrolled: ______________________________________

Length of course: _______________

What school activities have you been involved in? ____________________

_____________________________________________________________

What activities outside school have you been involved in? ______________

_____________________________________________________________

Have you participated in Legion Poster, Poems, Essay Competitions: _____

If yes, please advise how you fared out. _____________________________

Have you participated in Legion Public Speaking Competitions: _________

If yes, please advise how you fared out. _____________________________

In thirty words or less please advise why you should receive this Bursary:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Oh behalf of the Executive of the Royal Canadian Legion Branch 174, Arnprior “Thank You” for submitting this application. This document will be destroyed at the conclusion of the Branch Bursary Committee meeting that determines the winners of the Bursaries.

Applicants Signature: ___________________________

Note: The Legion reserves the right to authenticate all information pertaining to the application prior to any decision being made.

1

The Royal Canadian Legion Branch 174

COMMUNITY BURSARY APPLICATION FORM

Conditions1. The applicant must have received the Ontario Secondary School

Diploma.2. The applicant must be proceeding or attending a Post Secondary

Education at a University or College.3. The recipient shall be chosen by The Royal Canadian Legion

Branch 174 Bursary Committee.

Value: $500.00

Community BursaryEligible to students who are graduating/have graduated from Arnprior District High School and reside in the Town of Arnprior or surrounding area.

Applicants Status (check)

Son or Daughter of Legion Member Yes ___ No ___

Membership Number: ____________

Applicants Information

Name: ___________________________________ Age: ______

Address: _________________________________ Town: ____________

Prov: _____ Postal Code: _______ Phone: _____ - _____ - _______

Parent’s Name: _________________________ Phone: ___ - ___ - ____

1 of 2

Please check: University __________ College: ________

Name of Institution you plan on attending: ___________________________

Location: __________________

Type of course enrolled: ______________________________________

Length of course: _______________

What school activities have you been involved in? _________________________________________________________________________________

What activities outside school have you been involved in? ___________________________________________________________________________

Have you participated in Legion Poster, Poems, Essay Competitions: _____

If yes, please advise how you fared out. _____________________________

Have you participated in Legion Public Speaking Competitions: _________

If yes, please advise how you fared out. _____________________________

In thirty words or less please advise why you should receive this Bursary:

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Oh behalf of the Executive of the Royal Canadian Legion Branch 174, Arnprior “Thank You” for submitting this application. This document will be destroyed at the conclusion of the Branch Bursary Committee meeting that determines the winners of the Bursaries.

Applicants Signature: ___________________________

Note: The Legion reserves the right to authenticate all information pertaining to the application prior to any decision being made.

STOTT PERSEVERANCE AWARD

SPECIAL APPLICATION

NAME OF STUDENT:_____________________________________________________________(Donor will not be aware of name)

Social Insurance Number: _________________________________________________________

1. Obtained OSSD in 4 years Yes No

2. This is my graduating year Yes No

3. I am not continuing in post secondary school.

Describe how you have done your best while struggling with obstacle(s).

TOWNSHIP OF MCNAB/BRAESIDE – BURSARY

SPECIAL APPLICATION

NAME OF STUDENT: ____________________________________________________________

CIVIC ADDRESS: _______________________________________________________________

Please check the appropriate program and provide the specific program you are registered in / applied to.

Political Science ____________________________________________________

Public Administration _________________________________________________

Agriculture _________________________________________________________

Recognized Trade ___________________________________________________

Environmental Studies ________________________________________________

Rural Studies _______________________________________________________

History / Heritage ____________________________________________________

Be sure you have filled in of your community involvement and/or volunteer work and your extra-curricular involvement (within school or community or both) on your general application.

TRISHA LOUISE SMITH MEMORIAL AWARDSPECIAL APPLICATION FORM

NAME OF STUDENT:_____________________________________________________________

NAME OF UNIVERSITY ATTENDING:________________________________________________

Describe how the following sentence applies to you.

“A student who has given his/her personal best in athletics.”

Describe how you have displayed the ability to rise to a challenge.

Outline your involvement in school activity.(You may attach a photocopy of the personal information on your general application form.)

Describe how you have displayed your compassion for others at school or in the community.