Award Number: 45414, 45415, 45416 − 1 −

UMGSA Awards Application www.umgsa.org Updated: July 2019

Graduate Student Award Application Form Part I (To be filled out electronically)

Applicant Information

Name: Student #:

Department: Year of Study:

Level of Study (Ph.D./Master’s): Status (Full-time/Part-time):

Academic Reference (AR) Name: AR Phone #:

AR Email:

Community Member Reference (CMR) Name:________________________________________________

CMR Phone #:

CMR Email:

Mailing Address (as of August 1st of the current year):

Student Email:

Student Phone #:

FOR OFFICE USE ONLY

Received by: _ on at .

Verified by the Vice-President Academic on at

GCC

Award Number: 45414, 45415, 45416 − 2 −

UMGSA Awards Application www.umgsa.org Updated: July 2019

Graduate Student Award Application Form Part II A letter (500 words max.) to demonstrate dedication to scholarship and community involvement.

Award Number: 45414, 45415, 45416 − 3 −

UMGSA Awards Application www.umgsa.org Updated: July 2019

Graduate Student Award Application Form Part III

Declaration

I certify that I have carefully read all the material contained within this

application. I declare that all information provided is accurate. I authorize the

University of Manitoba Graduate Students’ Association Office and Awards

Committee to investigate the information provided to assess my qualification

for this award.

Signature of Applicant Date

Document Checklist

Completed Graduate Student Award Form (Parts

I, II & III).

Curriculum vitae that speaks to both your

academic as well as community involvement.

An academic letter of reference (preferably from

your advisor)e-mailed directly from your referee

to vpa@umgsa.org.

A letter of reference from a community member e-

mailed directly from your referee to vpa@umgsa.org

Graduate Student Award Application Form Part IGraduate Student Award Application Form Part IIGraduate Student Award Application Form Part III

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