Rotary Scholarship Registration Form

Rotary Club of Victoria-Harbourside

Telephone +1 250 - 257-1967

E-mail scholarships@harboursiderotary.org

Website https://www.harboursiderotary.org/page/scholarships
Pacific Design Academy

ADDRESS:
#200 - 8 Bastion Square, Victoria BC V8W 1H9
250 383 3631
info@pdaeducation.com
Rotary Scholarship Registration Form

This is your chance to learn from experienced professionals and build an outstanding portfolio. Don't miss this limited-time opportunity to invest in your future.

Basic Information
Full Name*

First NameMiddle NameLast Name
Phone Number*
Email*
example@example.com
Current Education Level*
for G12 or above
Diploma Program you interest with *
Birth Date*

MonthDayYear
Present Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact

First NameLast Name
Relationship
ex. Father, Mother, etc.
Phone Number Of Person To Contact In Case Of Emergency
Please enter a valid phone number.
Email Of Person To Contact In Case Of Emergency
example@example.com

Academic Background
High School Name*
High school Certificate and Transcript

File should be in pdf, doc/docx, png, jpeg/jpg format.
Cancelof
Extra Curricular Participation

Student CouncilClass OfficerClub/OrganizationVarsity PlayerOthers (please specify below)

Other Details
Letter of intent
(detailing your background and future goals in order to ensure the program meets your needs.)
Why you need this scholarship
Do You Have Any Other Scholarship?

YesNo
Who/what is the name of your sponsor?
What Is Your Plan After College?*
Comments
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