Application for Prestige Scholarships and Carleton Capital Scholarships

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1 Application for Prestige Scholarships and Carleton Capital Scholarships Prestige Scholarships Students submitting this application may be considered for one of the Prestige Scholarships listed below. Number of scholarships and value Ten Chancellor's Scholarships $30,000 Seven Richard Lewar Scholarships Three Carleton University Scholarships of Excellence Two Carleton University Shad Valley Scholarships of Excellence One Riordon Scholarship One Collins Prestige Scholarship ($7,500 x four years)* $21,500 ($6,500 in the first year and $5,000 in second, third, fourth year)* $20,000 ($5,000 x four years)* $20,000 ($5,000 x four years)* Full tuition in first second, third, fourth year* Full tuition in first second, third, fourth year* * Prestige Scholarships replace any previously awarded Entrance Scholarships. ** Prestige Scholarships are renewable with an Annual GPA of 10.0 (A- standing) Carleton Capital Scholarships Minimum average Students submitting this application may be considered for a Carleton Capital Scholarship. To be considered, students must be Canadian citizens, permanent residents or protected persons of Canada. Number of scholarships and value Up to 13 students selected, with one recipient from each province and territory in Canada. Minimum average $2000 in first year*** Non-renewable *** A Carleton Capital Scholarship may be awarded in addition to other Entrance or Prestige Scholarships. Instructions 1. Students submitting an application must have an admissions average of 90% or better plus have demonstrated leadership roles in their extracurricular activities. 2. Students should not include any additional attachments (e.g. résumés, portfolios, photos, certificates, etc.). However, if necessary, students may re-type the questions with their answers (this will not be considered an attachment). 3. Individuals completing the reference for the student may submit their recommendation as a separate attachment (only one reference per candidate will be considered). 4. Only candidates with no previous attendance at a post-secondary educational institution (college or university) will be considered. Students must be pursuing post-secondary studies for the first time. 5. This is a fillable form. Please complete, print, and submit this application to the Awards Office by March 1 (If the deadline date lands on a weekend, application must be submitted the first working day after the deadline date)

2 Carleton University Application for Prestige Scholarships and/or Carleton Capital Scholarships Section 1 to be completed by the candidate Last Name First Name Carleton Applicant/Student Number (100xxxxxx): Date of Birth (MM/DD/YY) Area code & home number: Program applied to: Major or Concentration: Citizenship: Canadian Permanent Resident Protected Person Visa/International I am completing this application for: Prestige Scholarships Carleton Capital Scholarships Both Prestige and Carleton Capital Scholarships Home Address: Street City/Town Province Postal Code Name of High School (last attended): School Address: Street City/Town Province Postal Code Section 2: Describe your academic and future goals and tell us how attending Carleton University will assist you in achieving them (Maximum 150 words):

3 Section 3: Tell us about extracurricular activities that you are involved with at your school and outside of school. Be sure to include leadership roles, clubs, offices held, athletic/artistic, volunteer work, community service, competitions, awards and employment. If more space is required, please attach a separate sheet with relevant information. Organization and Activity Role (e.g. participant, leader, founder etc.) Dates/ Duration (e.g. Sept June 2015) Total Hours

4 Section 4: Describe what you would consider to be your most important activity to date and what significant impact it has made to your school or larger community: Section 5: Is there anything else that you would like to tell us about yourself or your leadership skills and abilities? Section 6: Are you an alumnus of a Shad Valley Program? Yes No Shad Valley campus attended: Year attended: At Carleton University, we recognize and respect the importance of privacy. Personal information that we collect is kept confidential. In accordance with section 41 of the Freedom of Information and Protection of Privacy Act, Carleton University will only use the information in its custody or control in the following circumstances: where the individual identifies the particular information and consents to its use; for the purpose for which it was collected or a consistent purpose (i.e. a purpose which the individual might have reasonably expected). The Awards Office allows for disclosure or exchange of information to external and internal bodies as required determining eligibility/suitability for awards and the release of identifying information that may include name/program / year, to award donors and university units advising them of award recipients. From time to time, the university may also post this information in public forums, such as websites and/or notices or use this information for statistical or reporting purposes to agencies that have the authority to ask for such information. If you have questions and/or do not agree to the release of identifying information, please contact the Awards Office FIPPA Liaison Officer at awards@carleton.

5 Recommendation form for Prestige Scholarships and/or Carleton Capital Scholarships Awards Office Carleton University 202 Robertson Hall 1125 Colonel By Drive Ottawa ON K1S 5B6 Tel: Fax: Website: carleton.ca/awards This form should be mailed separately. Application deadline: March 1(if the date lands on a weekend, application must be submitted the first working day after the deadline date) Candidate data - to be completed by the student Surname Date of birth Given names Name of high school Home address Unit # School address City Province City Province Postal code Country Postal code Country Recommendation - to be completed by a secondary school official (teacher, guidance counsellor, principal, vice-principal) or community representative. The statement/recommendation may be submitted on a separate sheet of paper or letterhead. In order to help the selection committee, could you kindly provide a statement or separate attachment regarding the applicant's qualifications to receive a Prestige Scholarship and/or the Carleton Capital Scholarship. Please include your personal observations and experience with the candidate's leadership qualities and contributions to the school and/or community. Signature Name (please print) Date Position and Organization Length of time acquainted with candidate At Carleton University, we recognize and respect the importance of privacy. Personal information that we collect is kept confidential. In accordance with section 41 of the Freedom of Information and Protection of Privacy Act, Carleton University will only use the information in its custody or control in the following circumstances: where the individual identifies the particular information and consents to its use; for the purpose for which it was collected or a consistent purpose (i.e. a purpose which the individual might have reasonably expected).