Harry Jerome Scholarship Award 
Application Form

Applicants must submit the following:

  • Brief biographical letter noting family background, educational history and plans, 
    career/vocational aspirations.
  • Verified statement of marks or academic transcript
  • THREE letters of reference, one from each of the: principal, Track & Field coach
    and other appropriate sources
  • Completed Harry Jerome Scholarship Award application

Applicant’s Name: __________________________________________________________

Mailing Address: ___________________________________________________________

______________________________________________ Postal Code: ________________

Telephone: Day: (____)__________________ Evening: (____)_______________________

S.I.N. # _____________________ Date of Birth: Day:_____ Month:______ Year:________

Place of Birth:___________________________________________

Citizenship/Landed Immigrant Status: (Please check one)
__Canadian by birth  __Naturalized - Date:______ Cert. #:_____________    __Landed Immigrant

Length of Residence in British Columbia: _________________________________________

Secondary School:___________________________ Principal:________________________

School Address:______________________________________________________________

_________________________Postal Code:______________ Tel: (____)________________

Post-secondary Institute you plan to attend and program you plan to follow:_____________

___________________________________________________________________________

FINANCIAL INFORMATION

Anticipated income for the next term(s) of post-secondary study (not to exceed 12 months):
Personal Earnings:
Investment Income:
Family Support:
Other Non-Scholarship Support:
TOTAL:		  
 
 
 
 

Anticipated expenditures for the next term(s) of post-secondary study (not to exceed 12 months):
   
   
   
   
TOTAL:  

Other scholarships applied for:______________________________________________

_______________________________________________________________________

_______________________________________________________________________

Other financial (e.g. any financial pressures/problems that could occur):

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________