Centennial Scholars Entrance Award 2018/19 Student Application

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Centennial Scholars Entrance Awards (CSEA) assist students in making the transition to UBC from secondary school or another post-secondary institution. The purpose of this program is to financially support academically qualified students who show an interest in joining and contributing to the UBC community, but who would not otherwise be able to attend without significant financial assistance. This program offers new students renewable awards up to $40,000, payable over four years. There are opportunities for students studying on UBC's Vancouver campus to receive full-ride awards, ranging in value up to the full cost of a student's program and living expenses Criteria You are a strong academic student and meet all UBC admissions requirements. You demonstrate financial need. You are a Canadian citizen or permanent resident. You are entering directly from high school or transferring from another post-secondary institution You are applying to a direct entry undergraduate program at UBC and do not have a previous degree. You have a reference from a member of your school or community. Instructions Please read the instructions carefully before starting your application You must complete your admission application at you.ubc.ca and have a You must complete this application and upload it under Student Application You must also prepare and upload a Description of Circumstance: o Provide a statement outlining your and your family s financial circumstances that make it necessary for you to apply for a Centennial Scholars Entrance Award. Explain your interest in joining and contributing to the UBC community and how receiving this award will impact your personal situation now and in the future. o If you are applying to the UBC Okanagan campus and would like to be considered for the Finch Family Entrance Award, please include details of how you meet the following criteria: This award supports students who have graduated from a high school in British Columbia and who have demonstrated significant financial need, and exceptional work ethic, as well as academic strength o If you are applying to the Faculty of Arts at the UBC Vancouver campus and would like to be considered for the Meekison Arts Student Entrance Award, please include details of how you meet the following criteria: This award supports an academically qualified student with demonstrated leadership skills and an interest in joining and contributing to the UBC community, but who would not be able to attend UBC without significant financial assistance o If you are applying to the Vancouver campus, consideration for the Centennial Leaders will be given to students who demonstrate, in addition to academic merit, qualities such as leadership skills, involvement in student affairs, contribution to community service and/or recognized achievement in a field(s) of interest. o Formatting: Your submission must be no more than 1000 words double-spaced, in 12 point font. Please include your name and student number on every page. Allowed file types are gif jpg jpeg png pdf doc docx. If you have been out of high school for 48 months or less, you will need your parent/guardian(s) to submit Parent/Guardian Form under Supporting Documentation You must have a personal reference upload their Reference Form under Supporting Documentation o Reference Criteria: Your personal reference must not be a family member. Your reference must be well acquainted with you and able to comment on your character, interest in UBC, and financial circumstances. Personal references can include but are not limited to: coaches, teachers, counsellors, principals, supervisors from work or volunteer positions, family doctors, community or religious leaders Submit all required components of the application by the deadline. Late, incomplete, mailed, faxed, or emailed packages will not be accepted Timeline Completed applications (including Student, Parent/Guardian & Reference Form) must be received by December 1 st, 2017 All applicants will be notified by May 15 th, 2018 regarding their status

Student Information Surname Given Name Middle Initial(s) Date of Birth (YYYY/MM/DD) Home Phone Cell Phone Email address: Citizenship: o Canadian or Permanent Resident (Landed Immigrant) Student Declaration I hereby declare that the information on this application (including the Description of Circumstances) is, to the best of my knowledge, correct and complete. I understand that UBC retains the right to verify information on my application. If I am the recipient of an award, I understand that by signing this declaration, I authorize The University of British Columbia to: release to Award Adjudication Committee members the information provided in this application form; prepare a brief biographical profile to be used for award presentation ceremonies and receptions; release to award donors my name, contact information (mailing address, telephone number and email address), year and program of study, and other information relevant to the requirements of the award, for the purpose of maintaining donor relations and informing donors about the outcomes of their gifts.. Date (YYYY/MM/DD) Signature

General Information 1. Have you been outside of high school for more than 48 months? o Yes o No (You will be required to submit the Parent/Guardian Form under Supporting Documentation) 2. Will you be living with your parents during the September April academic period? o Yes o No 3. Is the government your legal guardian? o Yes o No 4. Are your parents deceased and you do not have a legal guardian? o Yes o No 5. Do you intend to apply for a student loan? o Yes o No If yes, please indicate the province or territory through which you applied/will apply: If no, please briefly describe how you will be financing your studies: 6. Do you have any children? o Yes (If yes, please fill out the Dependent Information Section) o No 7. Please indicate your marital status Expenses o Single o Married o Common-law o Divorced o Separated o Widowed (If Married or Common-law, please fill out the Spouse or Common-law Partner Information Section) 8. If you are living away from home what will your costs for return transportation be (to/from Vancouver/Okanagan)? Enter 0 if you are living at home. 9. What other expenses do you have for the study period (ie. incidental, medical, personal supplies, recreational activities) NOT including tuition or housing costs

Income and Savings 10. What was your reported gross income from line 150 of your 2016 Income Tax Return? If you did not file a return, enter your gross income from all sources both inside and outside Canada: _ 11. The net Value of RESPs in your name: _ 12. The net Value of RRSPs in your name: _ 13. The net value of the bonds, term deposits, guaranteed investment certificates, stocks and/or other investments in your name: $ 14. The net value of any other investment (your share) such as boat, RV, revenue/holdings, recreational properties, etc. (do not include principle residence or your principle vehicle as an asset): 15. Resources for the 2018/19 Academic Year: September 2018 April 2019 Applicants savings for the academic year Anticipated earnings from Part Time work during the academic year Parental and/or Spousal Contribution RESP funding for the academic year Social Assistance/EI/Disability Benefits etc Scholarships (excluding UBC) Bursaries (excluding UBC) Sponsored tuition/books Aboriginal Band Funding Other resources:

Dependent Information (complete only if answered Yes to Question 6): 16. Number of children Age 0 11 : 17. Number of children Age 12 18 who are not in post-secondary institution: 18. Number of dependent children who are in a post-secondary institution for whom you receive the Canada Child Tax Benefit or for whom you claim a benefit on your Income Tax Return: 19. Childcare costs for the study period: $ 20. Amount of childcare subsidy received for the study period: $ 21. Amount of child support/alimony paid during the study period: $ Spouse or Common-law Partner Information (complete only if answered Married or Common-law for Question 7): 22. Spouse/Common-Law Partner Name: 23. Occupation: 24. Employer: 25. Reported gross income from line 150 of your spouse or common law partner s 2016 Income Tax Return (if they did not file a return, enter their gross income from all sources both inside and outside Canada: _ 26. During the applicant s study period, your spouse or common law partner will be (check all that apply): o Working full time o Home with dependent children o Living with applicant o In full-time study o Other 27. If in full time study, will your spouse or common law partner be applying for financial assistance for the upcoming study period o Yes o No If no, please briefly describe how they will be financing their studies: 28. Please indicate the net value of any assets (their share) in your spouse or common-law partner s name (including RESP, RRSP, investments, recreational properties, etc): _ Remember to submit this form, along with your Description of Circumstance, for the Student Application. You will also be required to submit Supporting Documentation (ie. Parent/Guardian and Reference Form) by December 1 st to be considered for this award. Please refer to Page 1 for detailed instructions.