Bursary Application
NOTE: ALL INFORMATION SHARED ON THIS APPLICATION IS AND WILL REMAIN CONFIDENTIAL. Thank you for taking the time to fill out this bursary application. NOTE: This bursary is reserved for students over 24 years of age. The maximum amount awarded is $500.00 I would like to be considered for the Jose Eduardo Lopez Memorial Scholarship being offered by the Board of Directors. By completing this application I authorize the committee to collect information and references in order to evaluate my application.
Name
*
First Name
Last Name
Date of Birth
*
Gender
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Number
*
-
Area Code
Phone Number
Marital Status
*
Number of Dependants
*
Email
*
example@example.com
Career/Course Chosen
*
Student Number
*
Academic Year (For example: 2022-2023)
*
How much was your income in the last 3 months?
*
Are you currently employed?
*
Yes
No
Other
Name of Employer? (This field is required, if you answered "Yes" to the previous question)
Do you received any financial support? (Parents, guardian, husband/partner, relatives, friends, child or spousal support)
*
Yes
No
Amount
$
(This field is required, if you answered "Yes" to the previous question)
Have you applied for any other bursaries?
*
Yes
No
Amount
$
(This field is required, if you answered "Yes" to the previous question)
Have you applied for OSAP or bank loans?
*
Yes
No
Amount
$
(This field is required, if you answered "Yes" to the previous question)
Briefly explain why you are asking for this bursary and how the funds will be used:
*
Required Documents
The following documents must be attached with the JELMS bursary application.
Required: Proof of Identity (Applicants must be over 24 years old)
*
Browse Files
PLEASE REVIEW CHECKLIST FOR REQUIREMENT DETAILS
Cancel
of
Required: Proof of Address (To be considered, applicants must reside in Hamilton, Grimsby, Ancaster, Dundas, Flamborough, Stoney Creek, Waterdown, Binbrook, Hannon, Mount Hope)
*
Browse Files
PLEASE REVIEW CHECKLIST FOR REQUIREMENT DETAILS
Cancel
of
Required: Letter of acceptance from an educational institution or verification of enrolment as registered student at the time of application
*
Browse Files
PLEASE REVIEW CHECKLIST FOR REQUIREMENT DETAILS
Cancel
of
Required: Academic Expenses (If applicable, copy of tuition receipt, books, and/or equipment required for post-secondary education)
Browse Files
PLEASE REVIEW CHECKLIST FOR REQUIREMENT DETAILS
Cancel
of
Required: Letter of employment (If applicable)
Browse Files
PLEASE REVIEW CHECKLIST FOR REQUIREMENT DETAILS
Cancel
of
Required: Demonstrate financial limitations (personal tax assessment or parents/relatives tax assessment, OSAP documents)
*
Browse Files
PLEASE REVIEW CHECKLIST FOR REQUIREMENT DETAILS
Cancel
of
Required: Document of immigration status in Canada (Birth certificate, Canadian citizenship/Passport, permanent resident card, or letter of approval from the Canadian government)
*
Browse Files
Cancel
of
Make sure you review this checklist to ensure all required documentation has been submitted for review and consideration of your application. If all required documents are not submitted it may result in your application being disqualified:
*
Document of Identity (Must be over 24 years old)
Letter of acceptance from an educational institution or verification of enrolment as registered student at the time of application
Letter of employment (if applicable)
Demonstrate financial limitations (personal tax assessment or parents/relatives tax assessment, OSAP documents)
Proof of address (to be considered, candidates must reside in the Hamilton, Grimsby, Ancaster, Dundas, Flamborough, Stoney Creek, Waterdown, Binbrook, Hannon and Mount Hope)
Document proving your legal status in Canada (Canadian citizenship/passport, permanent resident card, or letter of approval from the Canadian government)
Documentation and Declaration Section: I declare that to the best of my knowledge, all the information I have given in this application is true and accurate.
*
THE JELMS Jose Eduardo Lopez Memorial Scholarship RELEASE FORM: Waiver to use likeness : I hereby grant JELMS permission to use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the JELMS and will not be returned. I hereby irrevocably authorize JELMS to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge JELMS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY SIGNING THIS SECTION I GIVE MY CONSENT.
*
Do you agree with above waiver
*
Yes
No
Other
Date:
*
-
Month
-
Day
Year
DATE OF SUBMISSION
Enter the message as it's shown
*
Submit
Should be Empty: