Tillotson Foundation Health Award (Champlain)

Lampe Foundation CFUW Sherbrooke & District offers a scholarship to local nursing students, male or female who are enrolled in the nursing program at Champlain College, Lennoxville Campus and who intend to practice in the Eastern Townships.

Priority will be given to students from the MRC of Coaticook or surrounding area.

Members of the Club value mentoring and would like both to keep in touch with former winners and to encourage former winners to keep in touch with each other.

ELIGIBILITY CRITERIA

Full-time student male or female
Canadian citizen or permanent resident
Study program in nursing.
Financial need
Ability to work in both French and English
Community Involvement

THE FOLLOWING DOCUMENTATION SHOULD ACCOMPANY THE COMPLETED FORM:

Copy of latest transcript
One signed letter of reference from a teacher or employer attesting to your potential to work in your chosen field and your language skill.
Note: This document can be sent directly via email to the foundation from the teacher or employer. This document 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 program

This scholarship is contingent upon the applicant providing proof of registration and remaining in an accredited CEGEP or university program.

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

Application Deadline

October 30

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)*
Other Education
Click + icon to add more fields
Institution Diploma / degree Years (YY-YY)
Describe your intended course of study (institution, degree or diploma, field of study, length of program).*
Please explain your career goals:*
Estimate your expenses for the next year (tuition, books, transportation, housing, child care, etc.)*
Click + icon to add more fields
Expense Estimate Cost ($)
Total
Indicate your sources of support (personal savings, employment insurance benefits, manpower training measure, part - time income, parents or relatives, spouse or p artner, loans, bursaries, etc.)*
Click + icon to add more fields
Income Source Estimate Income ($)
Total
Is there anything else you would like to tell us about yourself to help us select the successful applicant?
Describe your community involvement:
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: 100 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: 100 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: 100 MB.
A signed letter of reference from a teacher or employer attesting to your potential to work in your chosen field and your language skill
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.
Accepted file types: pdf, Max. file size: 100 MB.
- 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*
I certify that the information in this application is accurate and complete, to the best of my knowledge. If selected, I agree to have my name and place of study published 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.
Phone
This field is for validation purposes and should be left unchanged.

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Institution	Diploma / degree	Years (YY-YY)

Expense	Estimate Cost ($)

Income Source	Estimate Income ($)