SOUTHPOINTE ACADEMY SOUTH DELTA REGIONAL SCHOLARSHIP APPLICATION

Transcription

1 SOUTHPOINTE ACADEMY SOUTH DELTA REGIONAL SCHOLARSHIP APPLICATION (Please complete one application for each candidate) Attach Applicant s Photo Here Scholarship Application for September 2019 Grade: STUDENT INFORMATION: Date of Application: Deadline: Friday, March 29, 2019 Preferred Name: Care Card Number: Sex: M F Date of Birth: / / Country of Birth: Principal Language Spoken at Home: Month Day Year Citizenship: Canadian Citizen Landed Immigrant Other (please specify) Immigration status: non-canadians must submit proof of Landed Immigrant status for students and parents with application. EDUCATION HISTORY: Present School: Date of Enrolment: Phone #: Address: Fax #: Has the Applicant ever been suspended, expelled or been required to withdraw from any previous school? Yes No Indicate if any of the following apply. (If yes, please provide documents) Psycho-Educational Assessment (Psych Ed) Yes No ESL or ELL Support Yes No Individualized Education Plan Yes No Behavioural Plan Yes No In-class support or Learning Centre Support Yes No PLEASE ENCLOSE THE FOLLOWING DOCUMENTATION: Resume (1-page maximum) Statement of Interest Why Southpointe Academy? (500-word maximum) Evidence of other attributes, such as, creativity, innovation, initiative, motivation, leadership, cooperation, and good citizenship in school and the greater community. Letter of Recommendation/Reference Letter (2 maximum). Grade 9 Year-end Report Card, Grade 10 Mid-year/Term 2 Report Card Extra-Curricular Interests Sports/Teams: Other Organizations (Volunteering/Community Service): Interests: Arts/Music: Name two aspects of school life that are most important to you, the student. To be completed by the student:

2 Please indicate how you came to know about Southpointe Academy Advertisement Reputation Word of Mouth Alumni Connection Sibling Connection Other: Open House Website Referred by: HOUSEHOLD INFORMATION Applicant Resides with Both Parents Father Mother Guardian Parent / Guardian 1 FATHER MOTHER GUARDIAN Title: (e.g. Mr., Mrs.) Cell: Street Address: City: Province: Postal Code: Home Telephone: Work Address: Occupation: Employer: Work Number: Please send all Southpointe Academy correspondence to this address. Parent Citizenship Status Canadian Citizen Landed Immigrant Other (please specify) Parent / Guardian 2 MOTHER FATHER GUARDIAN Title: (e.g. Mr., Mrs.) Cell: Street Address: City: Province: Postal Code: Home Telephone: Work Address: Occupation: Employer: Work Number: Please send all Southpointe Academy correspondence to this address. Parent Citizenship Status Canadian Citizen Landed Immigrant Other (please specify)

3 Sibling Information: Date of Birth: / / Current School: Date of Birth: / / Current School: Date of Birth: / / Current School: FORM A STATUS OF PARENT/GUARDIAN (ADMISSION TO CANADA AND RESIDENCY) To be completed and signed by a parent or legal (court-appointed) guardian. (If legal guardian, attach copy of court order appointing you as legal guardian.) LAWFULLY ADMITTED INTO CANADA 1. I am (please select one): A Canadian citizen (if not born in Canada, please attach a photocopy of citizenship paper/card) A Permanent Resident (landed immigrant) (attach photocopy of landed immigrant status paper or PR card) Lawfully admitted into Canada under the Immigration and Refugee Protection Act (Canada) with one of the following documents (please mark the appropriate box below and attach photocopy of document): Admission as a refugee or refugee claimant Valid student permit for two or more years (or issued for one year but anticipated to be renewed for one or more additional years Valid employment authorization (work permit) for two or more years (or issued for one year but anticipated to be renewed for one or more additional years) A person carrying out official duties under the authority of the Visiting Forces Act or as an accredited diplomatic agent, preclearance officer, consular officer or official representative in Canada of a foreign government with a consular post in British Columbia. Other - Document description (must be cleared with Immigration Canada) RESIDENCY IN BRITISH COLUMBIA 2. I am a resident of British Columbia (please select one): Yes Residency address: CONFIRMING SIGNATURE 3. Parent/Legal Guardian s name: 4. Parent/Legal Guardian s signature: Date: The use of this form is recommended by the Independent Schools Branch, Ministry of Education, British Columbia, Canada

4 PARENT/CHILD DECLARATION I have read and understand the following: a) This scholarship application does not automatically admit the candidate to Southpointe Academy. The academic transcript, interview and testing results, personal recommendations, and the availability of space are taken into consideration prior to admission. b) All the following factors will be considered in the selection process. The successful applicant will: Be an outstanding secondary student who meets the School s academic standards for admission to Grade 11. Have already demonstrated excellence in one or more of the following areas: arts, athletics, community service. Demonstrate a willingness to become involved in and contribute to Southpointe s co- and extra-curricular programs. Commit to remain enrolled at Southpointe for Grades 11 and 12. Be a non-southpointe student who resides in South Delta. c) The successful applicant, and their parents, will be asked to consent to the School publishing the applicant name as the scholarship recipient in internal and external publications. d) Financial need may be considered in determining the successful applicant. e) The Southpointe Academy South Delta Regional Scholarship is an exemption to the Tuition fees for Grade 11 and 12, Application Fee and New Family Fee. It is also an exemption from the requirement to purchase a Southpointe Bond/Education Investment Deposit. f) What is not covered under the Scholarship funds: Field trips, Outdoor education fees, international trips, school/team uniforms Musical instrument and other equipment rentals g) Applicants will be judged by a selection committee comprised of the Head of School, a member of the Board of Governors, Senior School Principal, and Director of Admissions. h) Successful applicants will be invited to tour Southpointe Academy and interview with the Selection Committee. i) Decisions will be made in April 2019 regarding entrance to the School Year. j) The Selection Committee will have absolute discretion in awarding the scholarship. k) Full disclosure of all information pertinent to the student's application (academic, social, etc.) is expected. Failure to do so could result in withdrawal of an offer of admission. l) I understand, as does my son/daughter to the extent that age permits, that enrolment at Southpointe Academy is conditional on him/her demonstrating and maintaining self-discipline, tolerance towards others, and attributes of good character. I agree to support the procedures, rules, and values of the School.

5 Summary: Southpointe Academy is an educational enterprise serving a community of students, teachers, and parents. The success of the enterprise relies on all parties being fully committed to and contributing members of the school. For example, among other attributes of the school, students and parents are expected to uphold: The physical and psychological well-being of all other parties, The goals of the school and individual students, The focus on academic rigour, truth, trust, and honesty, The School s programs (academic, athletic, and co-curricular). If, in the opinion of the Head of School, a student s participation in the School is not in the best interests of either the School or the student, he/she will be required to withdraw from the School at a time (possibly during the school year) determined by the Head of School. Signed: Parent/Guardian Signature Date Signed: Student Signature Date Once Application and requested Documentation has been completed, please mail or deliver to: Southpointe Academy Attention: Selection Committee th Street Delta, British Columbia V4L 2B1 Questions: Visit Southpointe.ca or call or info@southpointe.ca