P.C.A.H.A. Scholarship Program
Application Form
Download MS Word Application Form Here
Form131
(Rev: Aug/04)
1. Personal Information:
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Name: |
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Address: |
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City: |
Postal Code: |
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Telephone Number: |
E-mail Address: |
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Current Hockey Association: |
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Team Name: |
Date of Birth: |
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From (Year) |
To (Year) |
Educational Institution Attended |
Program of Study |
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Describe your planned future course of study and the post-secondary institution(s) you hope to attend:
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List any scholarships, bursaries, awards, or other academic recognition you have received and the date or year received:
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Season |
Association |
Division |
Team |
Other Hockey-Related Activities (Specify) |
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2004-05 |
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2003-04 |
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2002-03 |
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2001-02 |
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2000-01 |
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1999-00 |
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If you are an active referee, please indicate your official's number:____________________
List any individual or team awards you have received in hockey:
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List contributions you have made to your community:
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List contributions you have made to your school:
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Submit a personal letter containing an outline of your qualifications (including academic achievements, community/school participation and service, hockey involvement, and other qualifications) plus any additional comments you feel will assist the selection committee when considering your application.
This application MUST be accompanied by the following:
______ Personal Letter (see item #10, above).
______ Letter from designated Association executive member, official, or team official.
______ Letter from your school Principal or Counsellor.
______ Copy of your most recent school report card(s).
______ Copy of your transcript of high school grades.
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Deadline: Friday, April 1, 2005
Send to:
PCAHA Minor Hockey Scholarships
#114 - 3993 Henning Drive
Burnaby, B.C.
V5C 6P7