Scholarship Application

SECTION ONE: PERSONAL INFORMATION

Application Type*

University Programme Technology Programme University Entrance (from High School)"

Name*

First Name

Last Name

Nick Name or Preferred Name

Date of Birth*

Gender*

Email*

Phone*

Home Address*

Address Line 1

Address Line 2

City

Province

Postal Code

Mailing Address (if different from above)

Address Line 1

Address Line 2

City

Province

Postal Code

Are you a CSEG Student Member?*

Yes No

Your CSEG Student Number*

The CSEG student membership application form is available here: https://cseg.ca/students/cseg-student-membership.

My Parent’s CSEG Membership Number

(for university entrance scholarship applicants only)

SECTION THREE: REFERENCES

Name and position of two references who will supply letters of recommendation:

At least one reference letter must be from a professor or instructor. A second letter of recommendation is desirable from a past or current employer.
Letters of recommendation must be emailed to csegf.scholarships@shaw.ca.
Two letters of recommendation must be received on/before the application deadline in order to have a complete application.

Name (Recommendation #1)*

Position*

Institution*

Email*

Name (Recommendation #2)*

Position*

Institution*

Email*

SECTION FOUR: FINANCIAL NEED

Please report your income this year and the previous two years:

Current Year*

Income*

Source of Income*

Year*

Income*

Source of Income*

Year*

Income*

Source of Income*

Please indicate scholarships that you have already been awarded or expect to receive. Include the year and scholarship amount:

Scholarship 1 Name

Year Awarded

Amount

Scholarship 2 Name

Year Awarded

Amount

Scholarship 3 Name

Year Awarded

Amount

Scholarship 4 Name

Year Awarded

Amount

Do you have any extenuating circumstances regarding financial need that the scholarships selection committee should be aware of? If so, please explain.

Limit 1200 characters

SECTION FIVE: GENERAL

Describe your extra-curricular activities and leadership roles including class or campus offices held, club memberships and organizations, sports activities, hobbies, etc...

Limit 1200 characters

Elaborate on the data presented in this application, describing how your education and experiences are preparing you for a career in geophysics (post-secondary students only).

Limit 1200 characters

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time*

Thank you for applying for a CSEG Foundation Scholarship.

Progress

SECTION ONE: PERSONAL INFORMATION

SECTION TWO: ACADEMIC INFORMATION

SECTION THREE: REFERENCES

SECTION FOUR: FINANCIAL NEED

SECTION FIVE: GENERAL