ABBVIE IBD SCHOLARSHIP -2024 (ENG)

ABBVIE IBD SCHOLARSHIP APPLICATION FORM 2024
Please Note: Fields with a red asterisk (*) must be completed.

Please ensure you have all supporting documents scanned and ready to upload before beginning your application. To prepare your application materials, please review the application requirements listed on our website. Failure to complete all required sections of the web form and/or to upload the mandatory supporting documents will result in the automatic disqualification of your application.

Once you begin the online application process you must complete and submit your application in one sitting, as you will not be able to save your information for a later time. If you exit the form before submitting your application, your work will NOT be saved.

Please be sure to submit your application ONLINE by Thursday, July, 2024. Applicaitons submitted after 11:59 pm (local time) on July will not be accepted.

If you have any questions about the application form or the application process please email info@ibdscholarship.ca. Please allow 2-3 business days for a response.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Email*
example@example.com
Confirm Email*
example@example.com
Gender*

MaleFemaleNon-binaryTransgenderIntersexOther
Date of Birth*

MonthDayYear
Date
What is your connection to Inflammatory Bowel Disease (IBD)?*

I have Crohn's diseaseI have ulcerative colitisI have indeterminate IBDI have another form of IBD
Gastroenterologist First Name*
Gastroenterologist Last Name*
IBD Nurse Name
Hospital or Clinic Name*
Hospital or Clinic Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you a permanent and legal resident of Canada?*

YesNo
What type of degree are you pursuing?*

AssociatesUndergraduateGraduateCertificateOther
What year of your program will you be entering in fall 2024?*
Is this a full time or part time program?*

Full TimePart Time
What area of studies are you pursuing?*
Name of the post-secondary institution*
Address of post-secondary institution*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Campus (if not main campus)
Criteria For Evaluation

All the following application questions will be evaluated and contribute to your final score
What is your approximate tuition for the 2024 - 2025 school year?*
How much money have you been awarded in scholarships and grants (or are expected to be awarded) for the 2024 - 2025 school year?*
Will you be working during the 2024 - 2025 school year?*

YesNo
If yes, how many hours a week?
Please provide any other information (maximum 150 words) that encompasses economic need. Please be specific:*
Please provide a summary (maximum 150 words) of any academic or community honours or achievements you wish to share with the selection committee:*
Please provide a summary (maximum 150 words) of your previous or planned involvement in the IBD community, including, but not limited to, volunteer work, social media, and/or education events:*
Supporting Documents
Please read carefully. To submit your application online, you must scan and upload ALL of your supporting documents in the dropbox fields below (total document file size must not exceed 20 MB).

All applicants are required to submit the following supporting documents:
1. A completed and signed Proof of Diagnosis Form from your treating health care professional.
2. A signed and dated Applicant Consent Form.
3. Two (2) letters of personal recommendation from a teacher, guidance counsellor, school official, coach, mentor, health care provider, professional colleague, or employer.
4. A one (1) page (500-word max.) essay outlining how you demonstrate your academic aspiration and strive to sustain an optimal level of wellness, allowing you to excel in reaching your personal and academic goals and inspiring others to do the same.
*To obtian the application forms and/or to review the essay requirements, please visit the AbbVie IBD Scholarship web page.
Upload your 1st Letter of Reference here:*

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Upload your 2nd Letter of Reference here:*

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Upload your signed Proof of Diagnosis Form here:*

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Upload your signed Applicant Consent Form here:*

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Upload your AbbVie IBD Scholarship Essay here:*

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Clinton Shard Memorial Scholarship

Please read the section below and complete the questions if you would like to be considered for the AbbVie IBD Clinton Shard Memorial Scholarship.
As of 2022 the AbbVie IBD Scholarship program awards one (1) of the fifteen (15) recipients with the Clinton Shard Memorial Scholarship in addition to the $5,000 scholarship funds. The recipient will be selected by Clinton's family to honour the memory and impact of Clinton Shard. Learn more about Clinton Shard and his award.

The recipient of this award is selected based on the following criteria:
- Studies, volunteers, and/or embodies a passion for the environment such as environmental sustainability/protection/rehabilitation or;
- Studies, volunteers, and/or embodies a passion for the arts or;
- Displays a commitment to their community through volunteer work and/or;
- Has been presented with or had to overcome economic, social, emotional or other hardship(s) as a result of or in addition to their IBD diagnosis.
Based on the selection criteria listed for the Clinton Shard award, IF you were selected to receive one of the fifteen scholarship awards, check "YES" if you would like to be considered for the Clinton Shard Memorial Scholarship.

YES
If you selected "YES"...referring to the selection criteria listed above, please explain why you would be a suitable candidate for the Clinton Shard Memorial Scholarship. Please be specific. *Disclosing personal information is optional. Any information submitted here will be shared with the selection committee and Clinton Shard's family. (300 words maximum)
Crohn's and Colitis Canada & AbbVie Canada

Below are questions required by Crohn's and Colitis Canada and AbbVie Canada.
I would like to receive information about volunteer opportunities with Crohn’s and Colitis Canada.*

YesNo
Are you interested in participating in any of the following opportunities?

Taking part in webinars or educational events to strengthen your knowledge and better manage your IBD.Connecting with others that have IBD to share stories, ideas, and advice.Volunteering at local Crohn’s and Colitis Canada fundraising events, such as Charity Galas and the annual Gutsy WalkVolunteering at for Crohn's and Colitis Canada patient programs like Camp Got2Go, Gutsy Learning Series, and Peer Support.
How did you learn about the AbbVie IBD Scholarship Program? Please select all that apply*

Physician or nurse's officeCrohn's and Colitis CanadaMediaInternet SearchScholarship Canada/Student Awards/Disability Awards websiteSupporting OrganizationsEducational Institution, guidance counselors, registrar's office or school mediaOther
From time to time, AbbVie may wish to contact selected applicants for educational and/or awareness purposes. Do you give permission for Crohn's and Colitis Canada to share your contact information with AbbVie?*

YesNo
Thank you for applying to the 2024 AbbVie IBD Scholarship Program.
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ABBVIE IBD SCHOLARSHIP APPLICATION FORM 2024

Criteria For Evaluation

Supporting Documents

Clinton Shard Memorial Scholarship

Crohn's and Colitis Canada & AbbVie Canada

Thank you for applying to the 2024 AbbVie IBD Scholarship Program.