NEW BRUNSWICK WOMEN'S INSTITUTE

							                        NEW BRUNSWICK WOMEN’S INSTITUTE
                         SCHOLARSHIP APPLICATION FORM

NAME OF APPLICANT________________________________________________

ADDRESS____________________________________________________________
_______________________________________TELEPHONE__________________

DATE AND YEAR OF BIRTH___________________________________________

NAME OF FATHER_______________OCCUPATON________________________

NAME OF MOTHER______________OCCUPATION_______________________

NAME OF SCHOLARSHIP APPLIED FOR_______________________________

FOR WHAT PURPOSE IS SCHOLARSHIP DESIRED______________________

SCHOOL TO WHICH YOU HAVE APPLIED FOR ADMISSION_____________

ADDRESS OF SCHOOL________________________________________________

NAME OF COURSE____________________________________________________

APPROXIMATE COST OF TRAINING PER YEAR________________________

Circle the highest grade completed and list highest diploma degree, date and
Institution awarding same:
High School         10 11 12__________________________________________

College Undergrad. 1             2    3    4________________________________________

NAEM OF NEW BRUNSWICK WOMEN’S INSTITUTE RECOMMENDING
APPLICANT:
BRANCH_____________________________________
SECRETARY_________________________________
ADDRESS____________________________________
ALL APPLICATIONS MUST BE SUBMITTED TO:
          NEW BRUNSWICK WOMEN’S INSTITUTE
          VICTORIA HEALTH CENTER, ROOM 279
          65 BRUNSWICK STREET, FREDERICTON, N.B. E3B 1G5
                            BY MARCH 31

PLEASE NOTE: The applicant is responsible for seeing that a transcript of school marks, a letter of
reference from a member of the school staff, or clergy, or employer, etc. and a letter of reference from a
supporting Women’s Institute are forwarded to the NBWI Office. Application should also include letter
from applicant, enlarging upon the information already given in the application form; the financial need;
community involvement; future plans, etc.

DATE________________________________(SIGNED)______________________