2025 Accessible Technology Scholarship
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Student Name
First Name
Last Name
Student Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent/Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Are you currently or have you previously participated in a program of or received a schoalrship from Easter Seals Nova Scotia?
Please Select
YES
NO
If you answered YES to the question above, please indicate the name of the program or scholarship and year.
Are you currently in receipt of an academic scholarship or bursary from another organization?
Please Select
YES
NO
Please indicate the name and location of the high school where you currently enrolled and what grade you are in
How much are you applying for?
Please Select
$1,000
$1500
$2000
Please Decribe what the financial grant will be used for and why you require it.
Overveiw of required technology with costs. Please Upload (screen shot)
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Application Letter - Please Upload Your Application Letter Here:
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DECLARATION: To complete this application, you must confirm that you understand and agree with all the following statements. Please check boxes.
I have cafefully read and understand the eligibility criteria for funding as described.
I have included my application letter as well as overview of technologywith anticipated costs
I agree that I will provide any and all necessary documentatio to complete this application.
I agree to use the funds awarded from this grant for the purposes stated in this application only and will provide receipt of purchases to the ESNS.
I agree to provide ESNS with a thank you letter and picture which will be used in our thank you and impact report to Scotiabank for making this funding possible.
I agree to ESNS using my name, picture and information about the award for reporting and marketing purposes.
I certify that the information provided in the application is accurate and true.
Signature of Student Applicant/Parent/Guardian
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
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