GC Global Citizenship Scholarship 2019 PART 1 OF 2 · GC Global Citizenship Scholarship 2019 PART 1 OF 2 Introduction To be eligible, you must be from an Aga Khan Academy operating

Global Citizenship ScholarshipPAGE 1

GC Global Citizenship Scholarship 2019PART 1 OF 2IntroductionTo be eligible, you must be from an Aga Khan Academy operating under the AKA agency of the Aga Khan Development Network,entering the first year of an undergraduate degree program at the University of Alberta in September 2019, and have an admission average of 80% or higher on coursework completed at the time of application. Applicants must have also demonstrated exceptional leadership contributions to school and community in grades 10, 11 and 12.It’s best to type your Activity Summary and Essay in a Word document that you can save. Once you are ready (don’t forget to spell check and proofread), “cut” and “paste” the text into the appropriate pages of the PDF application.

1. Complete Part 1 of 2 of this application.

PART 1A. Student Information

• Complete the Student Information section. Applications must be typed. You can type in the Portable Document File (PDF) application on screen.

B. Activity Summary• In point form, provide information about your high school extracurricular and community leadership activities.• List only those activities that have occurred within the last three years. • Limit your comments to those activities in which you have had a leadership role. Do not include paid positions.• Provide dates and estimated number of hours spent participating in each activity (e.g., 3 hrs per week,

September 2017–June 2018). • Use only the space provided and DO NOT include extra pages.

C. Have your Activity Summary verified and signed by a reference or school official who can verify your activities.

D. Essay• In 300 words or less, describe what you have learned from your IB experience. • Essays containing more than 300 words may not be forwarded to the selection committee. Use only the space provided and DO NOT include extra pages.

E. Print, sign, and date your completed application.

F. Reference Form (Two letters of reference are required)• Provide the Reference Instructions to your referees.• Reference forms must be signed, sealed and returned to you if submitting via mail. Alternatively, letters may be submitted to University of Alberta International

directly by your referee by e-mail (from a valid institutional or corporate e-mail domain only; public domain addresses such as Hotmail, Gmail, Yahoo, etc. cannot be accepted) to [email protected] by 11:59 p.m. MST, December 12, 2018. If sending via mail, your reference form must be received by December 12, 2018 to the address in Section 3.

G. Transcript• In order to be eligible for this scholarship, you must apply for admission to University of Alberta and submit (by e-mail or post) high school and/or

secondary school documentation showing any completed courses and grades to date, plus interim (midterm) results for courses still in progress to the University of Alberta by December 12, 2018. For information on how to apply for admission and where to send your transcripts, please refer to ualberta.ca/admissions/international/admission/transcripts-documents. Do not send additional copies of your transcripts to University of Alberta International when you submit your scholarship application.

Global Citizenship Scholarship 2019PART 1 OF 2

Global Citizenship ScholarshipPAGE 2

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2. Complete Part 2 of the Application, “Part 2 – Financial Need Assessment Form.”

3. Submission• Return all of the above directly by e-mail (from a valid institutional or corporate e-mail domain only; public domain addresses such as Hotmail, Gmail, Yahoo, etc.

cannot be accepted) to [email protected] by 11:59 p.m. MST, December 12, 2018. If sending via mail, your application must be received by December 12, 2018 to the address below.Note: Scanned or e-mailed nomination packages must be original, typed, and signed by the author (the University of Alberta reserves the right to verify any information received).Send applications to: Global Citizenship ScholarshipUniversity of Alberta International142 Telus Centre, 87 Ave & 111 St.University of AlbertaEdmonton, AlbertaT6G 2R3 Canada

Note: Failure to follow the application instructions will result in your application being deemed ineligible.

4. No late applications will be accepted. Please keep a copy for your records. (It is your responsibility as the applicant to ensure your application is submitted complete and by the deadline).The University of Alberta reserves the right to verify any information received.

Global Citizenship Scholarship – Part 1PAGE 3

GC Global Citizenship Scholarship 2019Part 1A: Student Information

Personal Information■ Mr ■ Ms ■ Mrs

Last Name First Name Middle Initial

Birthdate (mm/dd/yy) Telephone

Mailing Address City/Town, Province

Postal Code Country

E-mail

University of Alberta ID number (if known)

Academic Information

Grade 10 School Name

City/Town, Province Telephone

Country



Country



Country

High School Graduation Date: month year

School Population: _____________________________________________

School Composition: ___________________________________________(e.g., Grades 10 to 12, 1 to 12, etc.)

Are you attending an Aga Khan Academy?

■ Yes

■ No

Your plans for UniversityI’m interested in applying to the following Faculties/programs:(indicate top 2 choices)1st 2nd Choice

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

■ ■

Agricultural, Life and Environmental Sciences

Arts

Augustana

Business*

Campus Saint-Jean

Education

Engineering

Kinesiology, Sport, and Recreation

Law*

Medicine and Dentistry*

Native Studies

Nursing

Science

* Preprofessional year required

References Provided byName Ref 1: __________________________________________________

Org: _______________________________________________________

Name Ref 2: __________________________________________________

Org: _______________________________________________________

Global Citizenship Scholarship 2019Part 1B: Activity Summary

Part 1C: Reference/School Official Verification To be completed by Reference/School Official

GCTime Commitment

e.g., September 2017–June 2018, approximately 3 hrs per weekPosition Held

e.g. captainActivity/Group

name group/team and briefly describe your participation

Grad

e 10 A

ctivit

iesGr

ade 1

1 Acti

vities

Grad

e 12 A

ctivit

ies

Name (Printed) Position

E-mail Telephone

■ I confirm that I have read and can verify the activities listed on the Activity Summary.

Signature Date

Applicant Name (printed)

Part 1E: Applicant Signature


GC Global Citizenship Scholarship 2019Part 1D: Essay

Applicant Name (Printed): ____________________________________________________________

In order to properly evaluate your application, the selection committee would like to know more information about your leadership experience(s). Please answer the following questions in essay format drawing from your own experiences, using specific examples to describe your leadership activities and what you have learned from the experiences. Please keep statements to 300 words as extra pages will not be included for the selection committee.

1. The IB Diploma Program requires that you actively learn from the experience of doing real tasks beyond the classroom. What have you learned from these service experiences and how has this influenced your leadership skills?

2. How does the learning you describe above connect to your larger education and/or life goals??

I certify that the information contained in this application is complete and correct. I authorize the Office of the Registrar to access my academic transcripts. I acknowledge that in order to be considered for Scholarships and Awards my academic transcripts and letters of reference will be provided to an award selection committee, who may contact my referees for the purpose of award selection. I further acknowledge that the Office of the Registrar provides application information to academic and administrative units of the University of Alberta for the purpose of selecting and administering scholarships and awards. I am aware that the Office of the Registrar may use my name, program and award information in various publications, presentations, and announcements to promote the University and its award programs.

Personal information on this form is collected under the authority of Section 33 (c) of Alberta’s Freedom of Information and Protection of Privacy Act for authorized purposes including admission and registration, scholarship and awards, student services, alumni relations and fund raising, and university planning and research. Student’s and alumni’s personal information may be disclosed to academic and administrative units according to university policy, in accordance with federal and provincial reporting requirements; information sharing agreements with student governance associations, organizations and to contracted or public health care providers as required. For details on the use or disclosure of this information call the Registrar at (780) 492-3113 or see www.ipo.ualberta.ca.

XSignature Printed Name Date

Global Citizenship Scholarship 2019Part 1F: Reference Form Instructions


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RefereeNominations must be made by a school official.

1. RefereeComplete the reference form. Reference forms must be typed. You can type in the Portable Document File (PDF) on screen.

2. Reference FormComplete the leadership ranking and questions on the next page. Please keep your answers to 400 words. Reference forms must be typed, original, dated, and signed by the author. The University of Alberta reserves the right to verify information received.

3. Submission Return all of the above directly by e-mail (from a valid institutional or corporate e-mail domain only; public domain addresses such as Hotmail, Gmail, Yahoo, etc. cannot be accepted) to [email protected] by 11:59 p.m. MST, December 12, 2018. If sending via mail, your reference form must be received by December 12, 2018 to the address below.

Note: Scanned or e-mailed reference forms must be original, typed, and signed by the author (the University of Alberta reserves the right to verify any information received). Global Citizenship ScholarshipUniversity of Alberta International142 Telus Centre, 87 Ave & 111 St.University of AlbertaEdmonton, AlbertaT6G 2R3 Canada

If you have any questions, please contact UAlberta International at [email protected]

Last name First Name Middle Initial

Title E-mail Telephone

Signature DateX

Instructions for RefereesYou have been asked to provide a Letter of Reference for the University of Alberta Global Citizenship Scholarship (GC) Competition. The GC Committee relies heavily on these letters in selecting recipients. Please be honest and descriptive in describing why the applicant is worthy of such a scholarship, focusing on his/her leadership qualities and activities, not academic achievements. Applicants have until December 12, 2018 to apply, so be sure to return your letter before this date. Reference letters must be original, typed, signed, and dated even if you are scanning and e-mailing the document. Electronic submissions are accepted prior to 11:59 p.m. MST on December 12, 2018.

Applicant Name (Printed): ____________________________________________________________

Referee Information



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Leadership and IB Ranking Below Avg Avg Above AVG ExcellentOne of the few encountered in

my career

Engagement in student life ■ ■ ■ ■ ■

Leadership in student government ■ ■ ■ ■ ■

Leadership in student clubs/groups/teams ■ ■ ■ ■ ■

Leadership in community ■ ■ ■ ■ ■

IB performance ■ ■ ■ ■ ■

Potential for growth ■ ■ ■ ■ ■

Is this student currently at your institution on a scholarship? Yes ■ No ■

How long have you known the applicant, and in what capacity?

Additional Comments:

Academic Ranking Information:

Reference Questions:



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1.0 General Information First Name: _______________________________________________________ Last Name: _______________________________________________________

University of Alberta ID # Citizenship: ____________________________________________________________________

High School Name ___________________________________________________________________________________________________________________

Counsellor Name and E-mail ____________________________________________________________________________________________________________

1.1 Estimates of academic and living expenses for an eight-month period

Section 1: To be completed by student

1. Tuition and fees are approximations for the 2018–2019 academic year Fall/Winter terms and may increase following finalized fee assessment.

2. Shared accommodation is indicated above. Private apartments for undergraduate students is also available for an eight-month period for $5,600–$9,000 per year.

1.2 Sources of Financial SupportIndicate below the expected amount of annual support for each year of your degree program toward your educational costs from all sources. Do NOT list other awards or scholarships from theUniversity of Alberta. No other University of Alberta scholarships can be held in conjunction with this scholarship.

Sources of Support Support for 2019–2020 ($ CAD)

Projected support 2020–2021 ($CAD)



Family savings and earnings

Family income from investments

Loan or grant from government agency

Other (specify)

Total Sources of Support to be used in section 1.4

Do you have a source of emergency funds once you arrive in Canada? ■Yes ■No

If yes, please provide a brief description:

Program Agricultural, Life and Environmental Sciences; Arts, Augustana, Education; Campus Saint-Jean; Kinesiology, Sport and Recreation; Native Studies, or Science

Engineering Nursing

Tuition and Fees¹ ~$23,300 ~$27,700 ~$28,400

Accommodation shared² ~$8000 ~$8000 ~$8000

Food Included in Residence

Clothing $400 $400 $400

Books and Supplies $1,750 $1,200 $3,400

Miscellaneous $1,500 $1,500 $1,500

Total (CAD)³ ~$39,200 ~$41,700

Included in ResidenceIncluded in Residence

~$35,000



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Father/Guardian’s Name

Occupation

Employer

Sources of Annual Income Before Taxes Actual Income 2016 (CAD)

Pension

Interest/Dividends/Annuity

Rental Income

Income from other business

Other (including income from other investments)

TOTAL INCOME (A1)

1.3 Previous Financial Need Awards Please list the financial need awards that you received during your high school studies. Please attach a letter from school or award provided that confirms the details provided below.

Year School attended Name of Award Value of Award

Section 2: To be completed by parent(s)/guardian(s)

1.4 Declaration of Financial Need To determine your level of financial need, the University of Alberta will look at the costs of your program as estimated in Section 1.1 in relation to the contribution you and your family can make towards these costs (estimated in Section 1.2). Please calculate your net total financial need below:

$ ______________________ CAD

–$ ______________________ CAD

Cost of your program as estimated in Section 1.1

Minus total support available as estimated in Section 1.2 Total

amount of financial assistance needed for 2019–2020 $ ______________________ CAD

2.0 Financial Information



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Mother/Guardian’s Name

Occupation

Employer

Sources of Annual Income Before Taxes Actual Income 2017 (CAD)

Pension

Interest/Dividends/Annuity

Rental Income

Income from other business

Other (including income from other investments)

TOTAL INCOME (A2)

2.0 Financial Information (continued)

List of Family Expenses 2018 Actual Family Expenses 2018 (CAD)

Rent or mortgage payments

Food

Utilities

Clothing and household necessities

Education

Medical expenses

Insurance (home/life/etc)

Auto and/or other transportation costs

Entertainment and vacations

Taxes

Other (specify)

TOTAL EXPENSES (B)

INCOME (A1+A2) LESS EXPENSES (B)

2.1 List of dependentsHow many of your dependents, including the student identified in Section 1.0 above, are or will be in secondary school or university/college during 2018–2019 and for the next four years? List details.

Dependent Name & location of school currently attending in 2018–2019

Annual school tuition fees (CAD)

Amount paid by family (CAD)

Amount of scholarship provided by the school (CAD)

Amount provided by other sources (loans, grants, etc) (CAD). Explain.

Expected start and end dates (mm/yy to mm/yy)

Nominee

Dependent 2

Dependent 3

Dependent 4



GC2.2 List of Assets

Does your family own its place of residence? (home/apartment) ■ Yes ■NoWhat year was it purchased?

Original purchase price?

Amount owed on purchase price

Current market value

Other assets — list value of:Land and buildings (other than home noted above)

Savings and investment income (cash, stocks, bonds, etc.)

Other — please itemize:

Do you own a vehicle? ■ Yes ■NoVehicle 1 Make

Model

Year

Current Value

Vehicle 2 Make

Model

Year

Current Value

Please attach information for all additional vehicles

2.3 Family Debt or Financial Obligations Please list family debts other than on residence as noted above:

2.4 Additional Information Describe any special circumstances that you think the University of Alberta should take into consideration when assessing your level of financial need and the amount of support your family can provide (attach a separate page if space is insufficient):



GC2.5 Declaration of ApplicantI, ___________________________________ (applicant) certify that the information on this form is correct, complete and that I require financial assistance in order to pursue postsecondary studies at the University of Alberta. I understand that the University of Alberta retains the right to verify this information. I further acknowledge that Student Financial Support provides application information to various academic and administrative units for the purposes of selecting and administering scholarships and awards.

Personal information on this form is collected under the authority of Section 33 (c) of Alberta’s Freedom of Information and Protection of Privacy Act for authorized purposes including admission and registration, scholarship and awards, student services, alumni relations and fund raising, and university planning and research. Students’ and alumni’s personal information may be disclosed to academic and administrative units according to university policy, in accordance with federal and provincial reporting requirements; information sharing agreements with student governance associations, organizations and to contracted or public health care providers as required. For details on the use or disclosure of this information call the Registrar at 780-492-3113 or see www.ipo.ualberta.ca.

I, ____________________________________ (applicant) certify that the information on this form is correct, complete and that I have not withheld any information about me or my family’s financial situation and that I require assistance in order to pursue postsecondary studies at the University of Alberta.

Signature of Applicant Date

I, ___________________________________ (parent or guardian), certify that I have read the information provided by the Applicant on this form, that it is a true and accurate statement, and that the funds that have been identified as assured and projected are available and will be provided as indicated.

Signature of Parent or Guardian Date

I, ___________________________________ (parent or guardian), certify that I have read the information provided by the Applicant on this form, that it is a true and accurate statement, and that the funds that have been identified as assured and projected are available and will be provided as indicated.

Signature of Parent or Guardian Date

Documents

GC Global Citizenship Scholarship 2019 PART 1 OF 2 · GC Global Citizenship Scholarship 2019 PART 1 OF 2 Introduction To be eligible, you must be from an Aga Khan Academy operating