Alliance for Equality of Blind Canadians
Scholarship Application Form

PERSONAL INFORMATION

Name:
Street Address:
City:
Province:	-- Select One -- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Postal Code:
Home Phone:
Other Phone:
E-Mail Address:

EDUCATIONAL INFORMATION

Name of School or Institution currently being attended:
Street Address:
City:
Province:	-- Select One -- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
Postal Code:
Name of School or Institution You Plan to Begin Attending in the 2007-2008 Academic Year (if different from your current School/Institution):
Your Vocational Goal:
Major (if applicable):
Average academic grade of Current Academic Year or Most Recent year of Attendance at an Academic Institution as a percentage (required):

CHECKLIST: Please ensure that all relevant files are being submitted at this time. Incomplete applications will not be processed. Please refer to Documentation Required (opens in a new window) for further information.

Personal Letter outlining such information as vision and medical background, goals, interests, barriers, community activities etc. (No resumes please!):
Letter of Reference (from the last twelve months):

PRIVACY: The Alliance for Equality of Blind Canadians (AEBC) is committed to protecting the privacy, confidentiality, accuracy, and security of any personal information that we collect, use, retain, and disclose in the course of the programmes we offer. If you have any questions about protecting your personal privacy or our privacy policy, please feel free to contact our Compliance Officer by calling: (1 800) 561-4774 or by e-mail at: info@blindcanadians.ca.

I hereby certify that the information I have provided is correct and true to the best of my knowledge.
Send a copy of my completed application to me

Note: Applications must be received no later than October 15, 2007.