Lampe/Tillotson Champlain Science Scholarship

Awarded to a graduate of a science program at Champlain College Lennoxville Campus and from the Eastern Townships who intends to pursue further scientific studies.

ELIGIBILITY CRITERIA

Full-time student male or female
Canadian citizen or permanent resident
Financial need
Resident of the Eastern Townships for at least 3 years
Community Involvement

THE FOLLOWING DOCUMENTATION SHOULD ACCOMPANY THE COMPLETED FORM:

Copy of latest transcript
Two(2) letters of reference from a teacher or employer (at least one being from a teacher).
Note: These documents can be sent directly via email to the foundation from the teacher or employer. These documents may also be mailed via Canada Post directly to the Lampe Foundation. The address is on the form.
Proof of Canadian citizenship or Permanent Resident Status.
Proof of acceptance in a degree or diploma program.

This award is contingent upon the applicant providing proof of acceptance/registration and remaining in an accredited university program.

Decisions of the Scholarship Selection Committee are final.
All information will be treated in strictest confidence

Application Deadline

April 15

Award Amount

$1000

Full Name*
Prefix First Last
Present Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many years at this address?*
Permanent Address
- Same as present address
*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How many years at this address?*
Home Phone Number*
Cell Phone Number
Email Address*
I am a:*
- Canadian Citizen
- Permanent Resident
High School Name*
High School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Years Attended (YYYY-YYYY)*
Education at Champlain College*
Program name Program number Years (YY-YY)
Name and department of a professor who will recommend you for this prize.*
Name Department
Describe your intended course of study (institution, degree or diploma, field of study, length of program).*
Please explain your career goals:*
Describe your community involvement on campus:*
Describe your community involvement off campus:*
What other awards have you applied for, and have your applications been successful?*
Is there anything else you would like to tell us about yourself to help us select the successful applicant? This may include information about your personal circumstances.
Copy of proof of Canadian citizenship or Permanent Resident status*
This can be a copy of a passport, birth certificate, PR Card, etc.
We are currently only accepting PDF copies of the files.
Max file size: 2MB
Accepted file types: pdf, Max. file size: 256 MB.
Copy of latest transcript*
We are currently only accepting PDF copies of the files.
Max file size: 2MB
Accepted file types: pdf, Max. file size: 256 MB.
Copy of proof of acceptance in a degree program*
We are currently only accepting PDF copies of the files.
Max file size: 2MB
Accepted file types: pdf, Max. file size: 256 MB.
2. Two(2) letters of reference from a teacher or employer (at least one being from a teacher).
We are currently only accepting PDF copies of the files.
Max file size: 2MB
NOTE: This document can be sent directly via email to the foundation from the teacher or employer.
Drop files here or

Accepted file types: pdf, Max. file size: 256 MB, Max. files: 2.
- Check this box if your teacher or employer will contact the foundation directly via email or if the document will be mailed.
Terms and agreement*
Disclaimer for Privacy Policy – Scholarship Application
The Lampe Foundation is committed to protecting the privacy and confidentiality of all applicants for our scholarship programs. By submitting an application, you acknowledge and agree to the collection, use, and retention of your personal information as outlined below:
1. 1. Purpose of Collecting Personal Information
  The personal information collected during the scholarship application process is used solely for the purpose of evaluating and selecting scholarship recipients. This includes verifying eligibility, assessing financial need, and contacting applicants regarding the status of their application.
2. 2. Types of Information Collected
  The information we collect may include, but is not limited to, your name, contact details, academic records, financial information, personal statements, recommendation letters, and other relevant data necessary to evaluate your scholarship application.
3. 3. Use of Personal Information
  Your personal information will be used exclusively by the Lampe Foundation for the purpose of administering our scholarship program. This may include contacting you for additional information/documentation, contact information or for any follow-up related to your application. We will not share your personal information with third parties except where required by law or with authorized parties involved in the scholarship selection process.
4. 4. Retention of Personal Information
  Personal information submitted as part of your scholarship application will be retained for a period of 4 years, after the scholarship award has been made or after the scholarship cycle concludes. After this period, we will securely dispose of your personal information in accordance with our data retention policies, unless otherwise required by law to retain it.
5. 5. Data Security
  We implement reasonable security measures to protect your personal information from unauthorized access, disclosure, alteration, or destruction. However, we cannot guarantee the absolute security of your data.
By applying for a scholarship with the Lampe Foundation, you consent to the collection, use, and retention of your personal information as outlined in this disclaimer and our privacy policy If you have any questions or concerns regarding how your personal information is handled, please contact us at [email protected] or visit our Privacy Policy page.
on the CFUW Sherbrooke & District internet web site (cfuwsherbrooke.org),on Lampe Foundation website (www.lampefoundation.org) and on Lampe Foundation Facebook page.
- I agree to the terms and certify all all the above information is correct.
Comments
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Program name	Program number	Years (YY-YY)