Workplace Readiness Scholarship and Mentorship Program
Application Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you currently or have you previously participated in a program offered by Easter Seals NS?
Yes
No
If you answered 'Yes' to the question above, please indicate the name of the program you have or are participating in.
Are you currently in receipt of an academic scholarship or bursary from any other organization?
Yes
No
Indicate in the space below, the name of the college/university/institution where you are currently enrolled in (Fall 2026) or accepted and starting in (Spring 2027).
Indicate in the space below, the name of the program which you are currently enrolled in (Fall 2026) or will be starting in the Spring 2027
Length of Program
Start Date of Program
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you been offically accepted into your program?
Yes
No
Number of Years to Graduation
Briefly describe what you would use the $2,000 scholarship for if you were selected?
Do you plan to take part in the Mentorship program offered by Sun Life?
Yes
No
Unsure
Please describe what types of accommodation (if any) you would require to participate in the 9-month mentorship program and/or convene online with your designated volunteer mentor.
What ways would you prefer to communicate with your volunteer mentor?
Telephone
Email
Online video call (Zoom, MS Teams, etc)
If you are a successful scholarship recipient, do you agree to share your application letter with the scholarship donor?
Yes
No
If you are a successful scholarship recipient, do you agree to complete a survey about the mentorship program?
Yes
No
If you are a successful scholarship recipient, do you agree to provide a testimonial and picture of yourself to share with the scholarship donor and include in our annual gratitude report?
Yes
No
Please upload you One Page letter
Please upload your documentation confirming that you are currently enrolled in the Fall 2023/Winter 2024 semesters.
Please upload documentation outlining your disability.
Signature
Continue
Continue
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