Online Scholarship Application

Please be sure to read the Scholarships Criteria prior to completing the application form below.

The information provided in this application is confidential and will be used only for assessing the applicant’s eligibility for a scholarship from The Cmolik Foundation (TCF), and if successful, for matching with an assigned TCF Mentor or TCF Sponsor.

Part A: Personal Information

Your Full Name

Permanent Address

City

Province

Postal Code

Birth Date

Social Insurance Number

Home Phone

Cell Phone

Email Address

Number of Years in you have lived in BC

Name of Elementary School(s) Attended

Name of Secondary School(s) Attended

Name of the City Where Secondary School is Located

Anticipated Secondary School Graduation Year

Anticipated Date of Post Secondary Degree Completion

Parent/Legal Guardian's Name

Parent/Legal Guardian's Contact Number

Current Living Arrangements (check all that apply): Single parent/guardian Both parents Blended family Extended family Other, please explain:

Part B: Applicant Questions

Questions are designed to help the Selection Committee determine if you are a suitable candidate for a TCF scholarship and meet the criteria being used for selection. Shortlisted candidates will be interviewed. Please note that each question has a pre-set character count limit that cannot be exceeded.

Educational Goals (character limit 250 or less)
1. What are your educational/academic goals? (Identify the degree you hope to obtain, the major you have selected, and the post-secondary institution you plan to attend.) Why did you choose this area of focus?

0 / 250

Clear Future Focus (character limit 150 or less)
2. What do you envision yourself doing ten years from now?

0 / 150

Faced Adversity (character limit 1200 or less)
3. Describe for us a time when you or your family faced adversity. What was the adversity and the impact on your and/or your family?

0 / 1200

Proven Resilience (character limit 1200 or less)
4. Resilience is the ability to recover quickly from difficulties. Can you give us an example when you demonstrated resilience in your life?

0 / 1200

Positive Work Ethic (character limit 750 or less)
5. Give us some examples of where you have demonstrated a positive work ethic?

0 / 750

Financial Need (character limit 1000 or less)
6. In order to be eligible for a Cmolik Foundation scholarship you must have demonstrable financial need. (Total annual family income not exceeding $80,000). Can you explain to us why you meet this criterion? Is your family or extended family able to participate in funding your post-secondary education? If not, why not? And, how do you intend to support yourself through the years of your post-secondary education?

0 / 1000

Contribute to Community (Volunteerism) (character limit 750 or less)
7. In what ways have you made a positive contribution in your community (consider your school, family or local or broader community)?

0 / 750

Extra-Curricular Activities (character limit 750 or less)
8. Describe your extra-curricular activities, interests and/or achievements, including any paid work experience.

0 / 750

Academic Achievement (character limit 25 or less)
9. Considering English 12, a Social Studies 11, a Science 11 and Math 11, determine your estimated graduating Grade Point Average based on a 4.0 scale.

0 / 25

Goodness of Fit of TCF (character limit 500 or less)
10. Why do you feel you are a good candidate for this scholarship?

0 / 500

Paying it Forward (character limit 50 or less)
11. If your application is successful, do you commit, during your lifetime, to help fund another student through TCF or otherwise, who is not related to you?

0 / 50

Potential Income (character limit 250 or less)
12. What other scholarships have you applied for (list the title and amount)?

0 / 250

Resourcefulness (character limit 300 or less)
13. What resources have you leaned on in the past to help you through a challenging time?

0 / 300

Declaration:

I hereby apply for The Cmolik Foundation Scholarship and certify that the information given in this application is true and complete. The Cmolik Foundation has my authorization to verify the information contained herein with my educational institutions and other sources identified.

I hereby confirm I am a current resident of BC and I have lived in Canada for seven years.

I hereby confirm that I am a resident of British Columbia and have graduated or will be graduating from a British Columbia Secondary School, as defined in the eligibility criteria.

I hereby confirm that I have not previously received a major scholarship exceeding $25,000 for post-secondary education.

I hereby confirm that I need the financial assistance to attend a post secondary institution and my family total annual income does not exceed $80,000.

I hereby confirm that I will pay it forward by funding another non-related student sometime during my lifetime.

I hereby confirm that I have read and understand The Cmolik Foundation Reimbursement Guidelines and Rules.

I hereby acknowledge that, should I become a recipient of the Cmolik Foundation scholarship, my application, marks, and summaries may be shared with the Selection Committee, my future mentor and any potential sponsors as well.

I hereby acknowledge that my contact information may be shared with others in the Foundation for the purposes of organization of Foundation related events.

I hereby acknowledge that I am not eligible for the BC Provincial Tuition Waiver Program (for former youth in care).

Signature

By typing my signature and sending it via the Internet, I acknowledge that I have read and understand all information provided during the application process; that I agree with the stated declarations and that The Cmolik Foundation will rely upon it; that I intend to be bound thereby; and that I understand and agree that my electronic signature is the equivalent of a manual written signature.

Part C: Support Documents (Upload)

Please attach digital copies of each of the following documents. (jpg, png, pdf)

School principal's letter of support

Reference Letter #1

Reference Letter #2

Most recent transcript/report card

Photograph

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