GENERAL ENTRANCE AWARD APPLICATION Full name of applicant Dalhousie Student ID (if known): B 0 0 Date of Birth: D D M M Y Y Y Y Name of high school: I am applying to a program at: n Halifax campus n Truro campus (including Yarmouth Nursing) n both campuses (Faculty of Agriculture) NOTE: This is the application required to apply for Dalhousie s entrance awards, which are based on academic achievement, leadership, extracurricular activities, community service, financial need, and ancestry. The only exceptions are the Harrison McCain Scholarships, which require a separate application. Please see dal.ca/moneymatters for further information. General eligibility and conditions Entrance awards are open to students applying to Dalhousie University directly from high school who have a minimum admission average of 80% as of March 15. Eligible students must be entering a program within the Faculty of Architecture & Planning, Arts & Social Sciences, Computer Science, Engineering, Health Professions, Management, or Science. EXCEPTIONS - The First Nations & Indigenous Black Students Scholarships are open to both high school (min. 80% admission average) and transfer students (min. GPA of 2.70) currently registered in a program at another institution and entering a program on the Halifax campus. - Students entering the Faculty of Agriculture directly from high school are automatically considered for guaranteed entrance scholarships. Top academic applicants to the Faculty of Agriculture (minimum admission average of at least 80%) are encouraged to complete sections 1, 2 and 9 of this application to be eligible for the Atlantic Scholars Awards and sections 1, 2, 4, 7, and 9 to be eligible for additional application-based awards. Submit this application (and supporting documents as required) by March 15 to be considered regardless of whether or not you have received and/or accepted your offer of admission. Recipients must begin full-time studies at Dalhousie in the upcoming fall term following the date of notification of their awards. SUBMIT ALL DOCUMENTS BY ONE OF THE FOLLOWING METHODS: Mailing Address: Registrar s Office (Awards) Dalhousie University PO Box 15000, Halifax NS B3H 4R2 Courier Address: Drop Off: Henry Hicks Academic Halifax: Henry Hicks Academic Admin Bldg Admin Building - Room 130 Room 130, 6299 South Street 6299 South Street, Halifax NS OR Truro: Cox Institute, Room 100, 21 Cox Road Fax: 902-494-1630 Make sure to clearly label all supporting documents with your full name, date of birth, and student ID (B00) number (if known). Additional supporting documents (resumes, reference letters, etc.) are not required and will not be considered in the award assessment process (with the exception of the Alumni Association and Leadership Scholarships). In addition to this application, a candidate must have submitted a complete application for admission to Dalhousie (including the application fee, most recent official transcripts and supporting documents) by March 15 to be eligible. 2014/01 Please direct questions by phone to 902.494.2450 (Monday to Friday from 9:00 am 4:00 pm AST) or e-mail Awards@dal.ca. DEADLINE: MARCH 15 (postmarked by March 15)
SECTION 1 Activities (Required) Please list all community service, leadership activities, club/society/athletic participation, and employment for grades 10-12 in the appropriate sections. For each activity include a brief description, time commitment (hours/week), time period over which you were involved (MMYY MMYY), and a reference. Your reference should include the name and phone number of a teacher/leader/coach who can verify your participation in each of the activities you ve listed. Not all references will be contacted but a random selection will be called to confirm the number of hours per week and the time period over which you ve been involved. Supporting Documents Required (Halifax campus applicants only): If you wish to be considered for the Alumni Association/Leadership Scholarships, you must submit two reference letters: one letter from your high school (principal, counsellor, teacher, etc.) and one letter from a member of the community who has observed you in your activities. Reference letters must clearly identify your full name, date of birth, and student ID (B00) number. CLUB / SOCIETY / ATHLETIC Position Held / Description Time Period of Reference Name / Phone No. PARTICIPATION Commitment Involvement COMMUNITY SERVICE Position Held / Description Time Period of Reference Name / Phone No. Commitment Involvement
EMPLOYMENT Position Held / Description Time Period of Reference Name / Phone No. Commitment Involvement LEADERSHIP ACTIVITIES Position Held / Description Time Period of Reference Name / Phone No. Commitment Involvement SECTION 2 Short Answer Questions (Required) Please answer the following short answer questions on extra pages as required. The maximum word count per question is 750 words. Longer responses will not be considered. 1. Discuss a time when you ve faced a challenge. How did you tackle it and what was the outcome? 2. Describe a situation where you were required to be a leader. What qualities do you feel were required to be successful in your role? 3. Imagine yourself 10 years from today. What goals and ambitions do you have for yourself, personally and professionally? SECTION 3 Family Educational History (Optional) Halifax campus applicants only: Are you the first person in your immediate family (including grandparents, parents, and siblings) to attend a college or university? n Yes n No
SECTION 4 Financial Need Information (Optional) Many Dalhousie awards are given to applicants who have financial need. Our financial need-based awards are designed to help reduce barriers that students from low income families will face in their desire to complete post-secondary study. We aim to support students who have exhausted all their financial resources including government student loans, private bank loans, and family contributions but still have an outstanding financial need that will prevent them from attending university. When assessing financial need for scholarships and bursaries, the student s and the family s financial situations are considered. We determine the resources available to the student versus the base expense of attending university. We also pay particular attention to the student s initiative to fund their own education. When assessing financial need we look at the following: - combined family income, - the number of dependents sustained on this income, - the overall number of dependents who will be attending post-secondary study, - the expected family resources for university study (i.e. RESP, savings from student employment, etc.), and - extenuating circumstances that will affect resources. Supporting Documents Required: If you would like to apply for awards that are granted based on financial need, please complete the following section and submit copies of parental tax Notices of Assessment for 2012 to the Awards Office by March 15. Applications without supporting documents will not be considered. Where are you planning to live while attending first-year university (please check): n In residence at Dalhousie n Off campus (apartment) n With parent(s)/family Estimated Resources for the Upcoming Year Savings from summer employment Contribution from family Scholarships/Bursaries (do not include this scholarship) Part-time work during academic year Education/university trust fund Other (state source) Total Resources $ Occupation and annual income of parent(s) or guardian(s) If your parents are separated/divorced, please provide the information of the parent/stepparent who has custody of you. Mother/Guardian/Stepmother Name: Occupation: Employer: Annual gross income: Father/Guardian/Stepfather Name: Occupation: Employer: Annual gross income: Dependents: List names, ages, and relationships of individuals who are dependent on your parent(s) / stepparent(s). Name Age Relationship to you How many of the dependents listed above will be attending a post-secondary institution on a full-time basis during the upcoming academic year (including the applicant)? If parents are separated/divorced, please indicate which parent you live with and the amount of monthly child support received:
SECTION 5 Ancestry Information (Optional) Halifax campus applicants only: Self-identifying as a member of any of the groups below may offer you the opportunity to be considered for additional ancestry-based awards. Please note that consideration for these awards will not disqualify you for consideration for other entrance and renewable awards. Indigenous Black: An Indigenous Black person is one who: is the direct offspring of parents, at least one of whom is of African descent, and was born of parents living in one of the Maritime provinces at the date of birth; and whose African-Canadian parent(s) was (were) born in Canada. Are you Indigenous Black? n Yes n No If you answered yes, please complete the questions below. Applicant s Birthplace Caregiver/Mother s Ethnic Group Caregiver/Mother s Name Caregiver/Mother s Birthplace (ie. city/province/country) Caregiver/Father s Ethnic Group Caregiver/Father s Name Caregiver/Father s Birthplace (ie. city/province/country) First Nations: In accordance with the Constitution Act, 1982, Part II, Section 35(2), a First Nations applicant is an Indian, Inuit or Métis person of Canada, or a person who is accepted by one of the First Nations of Nova Scotia, New Brunswick or Prince Edward Island as a member of their community. Are you First Nations? n Yes n No If you answered yes, please complete the questions below. Are you a registered status Indian? n Yes n No If yes, what Band are you registered with? Reg.# Are you a member of any of the following groups? n Inuit n Métis n Non Status Are you registered with any Aboriginal/Inuit organization? n Yes n No If yes, which organization? If no, please explain your connection to your applicable aboriginal community: SECTION 6 Applicants with Disabilities (Optional) Halifax campus applicants only: Self-identifying as an applicant with a documented permanent disability may offer you the opportunity to be considered for additional awards including the Johnson Foundation Bursary, the DSU Accessibility Bursary, the Edward A. Perkins Memorial Bursary and the Suddy and Barbara Bill Ashfield Bursary. Please note that receiving one of these awards will not disqualify you for consideration for all other entrance and renewable awards. For the purpose of this application, disabilities are long-term or recurring impairments and include: learning disabilities; acquired brain injury; attention deficit hyperactivity disorder (ADHD); Asperger s syndrome; autism; chronic health conditions; hearing, speech and vision impairments; mental health disabilities; and physical and mobility impairments. Supporting Documents Required: If you would like to apply for awards that are granted based on having a permanent disability please complete the following section and submit a copy of your medical documentation confirming your permanent disability to the Awards Office by March 15. Applications received without supporting documents will not be considered. Do you have a permanent disability? n Yes n No
SECTION 7 Children of Dalhousie Facilities Management Employees (Optional) Open to eligible children, grandchildren, or spouses of Dalhousie s Department of Facilities Management employees (Halifax and Truro campuses as defined by Facilities Management). Please note that consideration for one of these awards will not disqualify you for consideration for all other entrance and renewable awards. Are you applying for the Facilities Management Employee Scholarship? n Yes n No Employee s name and relationship to you: Employee s Dalhousie ID (B00) Number: B 0 0 Employee s Position at Dalhousie: SECTION 8 Shad Valley Participation (Optional) Halifax campus applicants only: Did you participate in the Shad Valley program? n Yes n No SECTION 9 Release of Information and Authorization (Required) Protection of Privacy If you are awarded a scholarship, bursary, award, or prize, your name, hometown and program of study will be given to the donor(s) or your award(s) to encourage continued support of the Dalhousie award program. Please direct any concerns to the Registrar s Office, by phone 902-494-2450 or e-mail awards@dal.ca. DECLARATION I declare that the information provided on this application is complete and correct. I authorize Dalhousie University to verify any information provided as part of this application. I understand that the submission of false information may be subject to proceedings under the Code of Student Conduct (see current Academic Calendar for the section University Regulations ). I authorize Dalhousie University to release award information to the federal and/or provincial student aid offices. I understand that award applications are subject to audit. SIGNATURE OF APPLICANT DATE REMEMBER: if you have used our Self-Reported grades option on your application for admission, you must submit an official high school transcript indicating 1st semester finals and a list of 2nd semester courses or mid-year grades for scholarship consideration by March 15. Deadline: March 15 Postmarked by March 15 Registrar s Office (Awards) Dalhousie University 6299 South St Room 130 PO Box 15000 Halifax NS B3H 4R2