JEWISH IMMIGRANT AID SERVICES OF CANADA A non-profit Agency Serving Jewish Immigrants, Refugees, and Communities since 1922 4580 Dufferin Street, Suite 306, Toronto, Ontario, M3H 5Y2 Tel: 416.630.9051 Ext. 33 Fax: 416.630.9029 Email: national@jias.org NATIONAL SCHOLARSHIP APPLICATION FORM This application form can be used for: GENERAL SCHOLARSHIPS JOHN HIRSCH SCHOLARSHIPS FOR THE PERFORMING ARTS THE MARTA AND MICHAEL HERLING SCHOLARSHIP Applications must be post marked on or before the third Monday of April. Late entries will not be considered. Thank you for applying for a JIAS Canada National Scholarship. This application must be accompanied by an OFFICIAL SCHOOL TRANSCRIPT, COMPLETE FINANCIAL STATEMENTS (e.g. entire tax returns) for the last calendar year, A PERSONAL STATEMENT, and a copy of your IMMIGRATION PAPERS. LETTERS OF REFERENCE are to be sent directly to the JIAS offices by two referees. You must fill in all answers where appropriate. Incomplete application forms will be penalized. In order to be eligible for a scholarship, the applicant must have immigrated to Canada within the last nine years. The scholarships are for students taking full-time studies at the university or college level. JIAS Canada will contact all applicants after the Scholarship Committee has met.
NAME OF APPLICANT PLEASE TYPE OR PRINT LEGIBLY (please print): Family name Given names (Please note: preference may be given to those students who have not previously received scholarships form JIAS Canada) Section A: General Information Name: Sex: Male Female Home address: Apt# City Province Postal Code Social Insurance Number: Telephone: (Home) (Work) Occupation: E-mail Date of Birth: Place of Birth: Married: Yes No Date of Arrival in Canada: (Please attach your official school transcript/s) s (Please( attach a copy of your immigration papers) Section B: Non-Canadian Academic Background Name of School Dates attended From To Degree/Diploma indicate if expected or already Awarded High School or Technical School _ Post- Secondary School(University or College) _ Graduate/Professional School _ Section C: Canadian Academic Background (Please attach offi cial school transcript(s) from the Canadian School(s) you have attended) Name of School Dates attended From To Degree/Diploma indicate if expected or already Awarded High School or Technical School _
Post- Secondary School(University or College) _ Graduate/Professional School _ Section D: Academic Honours, Awards or Other Types of Recognition (Indicate both Canadian and non-canadian) Community activity Section E: Community Activities (include both Jewish and non-jewish activities) Name and phone number of advisor Other interests (clubs, organizations, sports, musical or artistic interest etc.) Section F: Financial Background Complete Part A if you are fi nancially dependent on your parents or others, or Part B if you support yourself A To be completed only if you are fi nancially dependent on your parents or others. 1. Fatherʼs Name: Occupation: Income: 2. Motherʼs Name: Occupation: Income: 3. List other family members who live in your household together with their ages and income. Name Age Income 4. Applicantʼs Occupation: Income:
5. Others who support you: Name: Occupation: Income: (Please include the entire Revenue Canada Income Tax Returns for the last calendar year for all those listed) B. To be completed if you support yourself 1 Are you currently employed? Yes No If yes, is your employment Full-time or Part time Name of Employer: Occupation: Income: Supervisorʼs name: Telephone No: (Please attach copies of all pages of your spouseʼs Revenue Canada Income Tax Return for the last calendar year) 2 If you are married, is your spouse currently employed? Yes No If yes, is he/she employed Full-time or Part-time Name of Employer: Occupation: Income: Supervisorʼs name: Telephone No: (Please attach copies of all pages of your 2008 Revenue Canada Income Tax Return) Section G: Career Plans and Future Goals List the schools, their faculties or departments, to which you have applied, at which you have been accepted, or in which you are already enrolled: Name of School/Faculty Applied/Accepted/Enrolled Scholarships/Financial Assistance List any scholarships and/ or fi nancial assistance you will be receiving and/ or are currently receiving and/ or for which you have applied:
Your Goals Discuss your educational aspirations, future career plans and life goals (you may need a separate sheet of paper for your answer to this question): Section H: Personal Statement Attach an additional statement regarding your academic, fi nancial or personal circumstances or any other facts which you feel will help the Scholarship Committee evaluate your candidacy for a JIAS National Scholarship Award. _ Section I: Letters of Reference Please arrange for letters of reference to be sent directly to us by two referees. Letters should be on offi cial letterhead where possible, and must be originals. Faxes and emails are not accepted. These letters should be from people who can assess your abilities and should not be from members of your family. The letters should be sent directly from the referees to the JIAS National Offi ce and should arrive in our offi ces by no later than the third Monday of April. Please give the names of your referees below: Reference No. 1 Reference No. 2 Name Address Name Address Telephone No Position Telephone No Position Section J: Declaration I hereby certify that all the information on this form is true and complete to the best of my knowledge. If requested, I agree to give further proof of the academic and fi nancial information that I have presented on this form Signature: Date:
DID YOU: Ø Complete the entire application? Ø Attach proof of date of landing? Ø Attach an offi cial school transcript? Ø Attach income tax returns for the year last calendar year for all people who support you fi nancially? (Notices of assessments are not acceptable) Ø Attach your personal statement? Ø Ask your referees to submit letters directly to us by no late than the third Monday in April Ø Make a photocopy of the application and all attachments for your personal records? Applications must be submitted in hard copy, should be postmarked by no later than, the third Monday in April and should be mailed to: Jewish Immigrant Aid Services of Canada National Scholarships Committee 4580 Dufferin Street, Suite 306, Toronto, Ontario M3H 5Y2 All documents will be kept in strictest confi dence