scholarship application 2011 - canadian hemophilia society

CHSQ 2011 Scho larsh ip Program

In co l laborat ion w i th CSL Behr ing, Bayer and Novo Nord isk

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Application form



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Genera l in format ion about scho larsh ips and bursar ies Thanks to the contributions of CSL Behring, Bayer, Novo Nordisk, the CHSQ offers three (3) scholarships valued from $1250 to $2000 for the 2011 academic year.

Descr ip t ion o f the two categor ies Academic scho larsh ips Scholarships are intended for members who have a bleeding disorder and studying at the collegial or university level, or at a vocational institution. The scholarship recipients in this category receive a scholarship valued at $1250 to $2000 for the 2011-2012 academic year. Mature s tudent bursary This category includes members with a bleeding disorder wishing to return to school, to take continuing education classes in their field or to begin a course of studies at any level. The recipients in this category receive a bursary valued at $1250 to $2000 for the 2011-2012 school year.

Goa ls o f the scho larsh ip and bursary program Encourage young people living with a bleeding disorder to continue their collegial, university or vocational studies Encourage people with a bleeding disorder to return to school or follow a continuing education course in their field.



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Admiss ib i l i t y c r i ter ia for the var ious categor ies Academic scho larsh ip • Be a Quebecer living with a bleeding disorder • Be a student in a recognized collegial, university or vocational institution • Be a member of the CHSQ • Have received no more than two consecutive bursaries or scholarships in the past three years Mature s tudent bursary • Be a Quebecer living with a bleeding disorder • Be registered in a recognized academic institution so as to return to studies or be registered or intend to

register for a vocational course. • Be a member of the CHSQ • Have received no more than two consecutive bursaries or scholarships in the past three years.

App l icat ion dead l ine and documents requ ired A selection committee composed of members chosen from the CHSQ will be responsible for evaluating applicants

and selecting recipients.

The deadl ine for submiss ion o f completed appl icat ions and support ing documents is midn ight , September 30, 2011. The dec is ions o f the Commit tee w i l l be announced dur ing the month o f November 2011. All applications and supporting documents must be sent to:

Canadian Hemophi l ia Soc ie ty – Quebec Chapter 2011 Scho larsh ip program

1102 - 2120 Sherbrooke East Montrea l , QC H2K 1C3



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Documents for a l l app l icants to supp ly

• The completed application form included in this package • An recent photo • Up-to-date curriculum vitae

Documents to supp ly accord ing to category

App l icants for academic scho larsh ips :

• A letter from your treating doctor or a representative of the medical profession confirming that your medical status meets the criteria for admission to the program

• Proof of registration at a collegial, university or vocational institution

• Official transcript of final scholastic year completed; this can be returned upon request

• Three (3) letters of recommendation no more than two years old with at least one written by a

teacher. These letters must attest to the ability and suitability of the applicant for the chosen program, as well as a character reference. A letter from a relative will not be accepted, unless the student has worked or is working for this person.

• A 500-word essay on the following subject: “Describe how your bleeding disorder and the CHSQ

have had an influence on your academic and/or professional experience. “



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App l icants app ly ing for mature s tudent bursary :

• A letter from your treating doctor or a representative of the medical profession confirming that your medical status meets the criteria for admission to the program

• Proof of registration at a collegial, university or vocational institution (if registration depends on you

receiving this bursary, you can supply this document between now and the end of 2011).

• Three (3) letters of recommendation no more than two years old with at least one written by a teacher. These letters must attest to the personal and professional suitability of the applicant. A letter from a relative will not be accepted, unless the applicant has worked or is presently working for this person.

• A 500-word essay explaining the applicant’s motivation for taking a professional course or for

returning to his or her academic studies.



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App l ica t ion form Sect ion A: Persona l in format ion Fami ly name: F i rs t name: Date o f b i r th : Address : (number and s t ree t) C i ty : Prov ince : Posta l code : Te lephone : (Home) (Work) : E -ma i l : Mai l ing address ( i f d i f ferent f rom above): Number and s t reet : C i ty : Prov ince : Posta l code :



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To be completed by the app l icant

Name of app l icant :

Sect ion B: Cho ice o f inst i tu t ion If you wish to register for the first time at a CEGEP, university or vocational institution, please enumerate, in order of preference, the three institutions to which you have applied: 1st choice

2nd choice 3rd choice If you are already studying at a CEGEP, university or vocational institution, please supply the following information: Name of the institution: Program of studies: Faculty (if relevant):



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Name of app l icant : Sect ion C : References Names and coordinates of people who signed letters of reference (these must be included with the application): 1. Name:

Address: (Number and street)

(City) (Province) (Postal code) 2. Name:


(City) (Province) (Postal code) 3. Name:


(City) (Province) (Postal code)



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Name of app l icant

Sect ion D: Vo lunteer and communi ty invo lvement o f app l icant

Please state, in order of importance, the school, professional or community work activities in which you have been involved in the past. In one sentence, explain why they were important.

1 . Act iv i t y and dura t ion o f your par t i c ipa t ion

Your job , ro le or pos i t ion :

Comments :



Comments :



Comments :



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Sect ion E: Essay Please include a typewritten essay of approximately 500 words that meets the requirement as defined in each category of scholarship or bursary (see pages 5, 6 and 7 of this document).



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Contro l l i s t o f app l icants

For a l l app l icants • Completed form: �

• Recent photo: �

• Up-to-date curriculum vitae: �

• Three (3) letters of recommendation no more than two years old: � • Essay: �

Appl icant for an academic scho larsh ip :

• Letter from treating physician: �

• Proof of registration in an institution: �

• Official transcript of marks from the final scholastic year completed: �

Appl icant for mature s tudent bursary :

• Letter from treating physician: �

• Proof of registration at an institution or in a vocational course (if available): �