Alouettes Bursary Program
2016 bursary application form
Secondary and college levels
Family name: _____________First name(s): ________________________
You must complete a form for each category in which you are applying.
Check the applicable bursary category :
Secondary level:
Athletic Excellence for 11th grade graduates
Academic Excellence for 11th grade graduates
Athletic Excellence for 10th grade graduates
Academic Excellence for 10th grade graduates
Perseverance for 11th grade graduates
Leadership for 10th or 11th grade graduates
Perseverance for 10th grade graduates
College level:
Athletic Excellence
Leadership
Academic Excellence
P R O C E D U R E
1. Read the eligibility and selection criteria.
2. Fill out the bursary application form, providing maximum information, all-star selections, statistics, etc. For
the leadership or perseverance category, the last 2 pages of this form must be completed.
3. For secondary students, provide grades for the third semester of Grade 10 or 11 by June 11,
2016. For college level students, send complete transcript of 2015-2016.
4. Send by email a well identified high resolution (at least 600 KO) action shot where the player is clearly
visible .
5. For RSEQ LEAGUES, return the form by June 10, 2016 to Mrs Diane Perron by e-mail (preferably) at
[email protected] or by regular mail to her attention at:
Réseau du sport étudiant du Québec
4545, ave. Pierre-de Coubertin, Montréal (Québec) H1V 0B2
6. For FOOTBALL QUÉBEC CIVIL LEAGUES, return the form by June 10, 2016 by e-mail (preferably) at
[email protected] or by regular post to:
Football Québec
4545, ave. Pierre-de Coubertin, Montréal (Québec) H1V 0B2
7. The deadline for candidate submissions is Friday, June 10, 2016.
To receive confirmation of receipt of your application form, please include your e-mail address:
___________________________________________
Program administered by the Quebec Foundation for Athletic Excellence and Football Québec,
in collaboration with the Réseau du sport étudiant du Québec (RSEQ).
PERSONAL INFORMATION
Family name:__________________________First name(s): _______________________
ADDRESS
ADDRESS OF PARENTS (if different)
_______________________________________
(Number, street, apt.)
_______________________________________
(Number, street, apt.)
_______________________________________
(City, province)
_______________________________________
(City, province)
__________________ (_____)_____________
(Postal code)
(Telephone)
___________________(____)______________
(Postal code)
(Telephone)
(____)_________________________________
(Cellular phone number)
_______________________________________
(Social insurance number)
_______________________________________
(Date of birth day/month/year)
_______________________________________
(E-mail)
SPORTS INFORMATION
YEAR
TEAM OR CLUB (Jersey
Number and Position)
COACH
2013-2014
2014-2015
2015-2016
2016-2017
Have you already been part of the excellence programs of Football Québec,
Challenge Wilson, or the MU15, MU17 or MU20 programs, Team Canada?
If yes, indicate which program and when____________________________________
______________________________________________________________
INDIVIDUAL STATISTICS
Provide individual statistics for position(s) played: pass completion percentage, yards gained, touchdowns,
points, field goals, success percentage, average yards per field goal, average yards per punt, punt returns,
kickoff returns, passes caught (percentage and average yards), tackles, sacks, special teams tackles,
interceptions, fumble recoveries, etc.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
SPORTS AWARDS
All-star selections, offensive or defensive player of the year, team player of the year, school athlete of the
year, student-athlete, etc.
MONTH/YEAR
NATURE OF AWARD
Athletic objectives 2016-2017
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
ACADEMIC INFORMATION
YEAR
INSTITUTION
MAJOR
DIPLOMA
2013-2014
2014-2015
2015-2016
2016-2017
Will you be a full-time student in September, 2016?
Yes
No
Yes
No
Have you received academic honours or distinctions?
Month/Year
NATURE OF AWARD
N.B.: Please include a copy of your secondary or college academic grades –
MANDATORY
RESERVED FOR PERSEVERANCE BURSARY APPLICANTS
Explain why you are a good candidate to receive a perseverance bursary this year.
What methods did you use to achieve your goals?
RESERVED FOR LEADERSHIP BURSARY APPLICANTS
Describe the deeds or ongoing activities in which you have participated to change
or improve conditions in your community. Also, describe the roles and
responsibilities that demonstrate your leadership abilities, particularly your capacity
for motivating and leading others.
Indicate the duration and extent of your involvement. You may include personal
references or documents in support of your application.
Formulaire révisé le 13 avril 2016.