Delta Secondary School

Deadline: April 21, 2021 @ 3pm

Instructions:	Print all information in pen

General Information:

Surname:_________________	Date of Birth:__________________

Given Name (first):_____________________Preferred Name:________________

Email address & cell number:__________________________________________

Post-Secondary Information:

Are you planning to continue your education in September 2021? Yes __ No__

If yes,

Name of Institute:_______________________________________________

Program Name:_________________________________________________

Alternate Post-Secondary Choice:__________________________________

If no,

Will you be attending a post secondary institution within 3 years of graduating?

YES _____ NO ______

Career Goal:

__________________________________________________________

Please list any other awards or scholarships you have been offered/receiving

(for Valedictory purposes):__________________________________________

Grade 11 Final Marks	Grade 12 First and Second Quarter Marks	Grade 12 Third and Fourth Quarter Courses & Interim/Final Marks	Online Courses Interim/Final marks
Course	Mark %	Course	Final Mark %	Course	Mark %	Course/Mark

Extra-Curricular Activities: Do not include course credit or work experience

School Involvement: Clubs, OrganizationActivities
Year/s (ie. 2014-2021)	Role	Total Hours of Involvement (not per week/year)	Achievements & Most proud of
Team Sports (School and Community)
Year/s (ie. 2014-2021)	Role	Total Hours of Involvement (not per week/year)	Achievements & Most proud of
Volunteer Community Participation
Year/s (ie. 2014-2021)	Role	Total Hours of Involvement (not per week/year)	Achievements & Most proud of
Other
Year/s (ie. 2014-2021)	Role	Hours of Involvement (not per week/year)	Achievements & Most proud of

I certify that the information in this application is correct:

Student Signature__________________	Parent Signature_____________________

YOU MUST BE ATTENDING A POST SECONDARY INSTITUTION WITHIN THREE YEARS OF GRADUATING FROM HIGH SCHOOL TO REDEEM YOUR SCHOLARSHIP/BURSARY

Some Awards list “Being in Financial Need” as part of the criteria. Please indicate on a

separate piece of paper the circumstances of your financial need