J.S.Woodsworth S.S.

Memorial Scholarship Application Form 2012

This scholarship was created to commemorate J.S. Woodsworth Secondary School which operated in the former Carleton Board of Education and subsequently the Ottawa-Carleton District School Board from 1973 to 2005. It is available to a student who meets the criteria listed under To Qualify. The value of the scholarship is $1,000.

TO QUALIFY:
The student is graduating from Merivale High School in June 2012. Preference will be given to a student who has earned an average of at least 80% either in six grade 12 subjects, or in at least six courses in his/her graduating year; The student has gained admission to, and will be attending, a Canadian college or university beginning the following September (or January); The student has demonstrated several of the characteristics for which the schools namesake was renowned, as embodied in the following four JSW criteria: 1. Student has worked to create a heightened awareness or reduce the impact of injustice and inequality in our community; 2. Student has been actively involved in social issues through a religious, political or other local organization or agency; 3. Student has taken action to better the circumstances of, or heighten awareness about, immigrants, visible minorities or persons with disabilities in our community; 4. Student has demonstrated volunteerism, co-operation, peace-building, leadership and advocacy.

TO APPLY:
Submit the attached application, fully completed and signed. The Applicant Achievements table should emphasize activities which relate to one or more of the above four JSW criteria; Submit an original typed essay, of 250 to 350 words in length, describing your community involvement(s) as outlined in the above four JSW criteria. Please comment on what you feel was accomplished and what you learned from the experience, which you may draw upon in the future; Ensure that an Academic Letter of Reference Form is submitted which addresses the above four JSW criteria, written by a principal, guidance counsellor, or teacher. This letter can come from someone in one of these positions in either your Grade 11 or Grade 12 academic year; Ensure that one or two Organization Letter of Reference Form(s) are submitted from persons in a leadership position who have supervisory knowledge of your contribution in the community group(s) or organization(s) with which you have been involved and upon which this application is based. At least one Organization Letter of Reference must be submitted from an organization and referee from outside the school community. Submit a copy of your most recent Credit Counselling Summary or Academic Transcript.

DEADLINE AND SUBMISSION:

The deadline for submission of the application is Friday, May 25, 2012; Four copies of the application materials shall be submitted to Merivale High School, 1755 Merivale Road, Nepean, Ontario, K2G 1E2, Attention: JSWSS Memorial Scholarship Committee; Questions about the submission process may be addressed to the Committee chair at [email protected]; A written acknowledgement of the Committees receipt of a candidates application will be emailed to the candidate in May. It will indicate whether or not the applicant has met the mandatory conditions for being considered; The decision of the committee is final and subject to receipt of a copy of the students final report card for 2011-12 a copy of the students letter of admission to a Canadian university or college and the students graduation from Merivale High School.

J.S.Woodsworth S.S. Memorial Scholarship Application Form 2012

Name: Date of Birth:

Address

City

Province

Postal Code

Email Address:

Telephone Number:

Name of current secondary school:

Years attended:

Names of other secondary schools attended (if any) and years attended:

Average Mark School Year 2010-11:

Average Semester 1 Year 2011-12:

Average Term 1 Semester 2 Year 2011-12:

Name(s) of Canadian post-secondary institution(s) to which you have applied (attach letter(s) of acceptance if received):

Anticipated course of study and degree/diploma sought:

Anticipated Start Date:

List up to three careers or occupations in which you are interested:

Is there any other information you wish the committee to have in consideration of your application?

Using the attached table, summarize your community involvement, extra-curricular activities and employment history (if applicable). If you have a previously filled out Record of Applicant Achievements, you may submit that, and continue with the attached table for subsequent activities and achievements.

Applicant Achievements
The table below represents a record of my involvement and achievements in my school(s) and community. The Applicant Achievements table should emphasize activities which relate to one or more of the above four JSW criteria. Academic Year(s) Sport, Club, Activity, Achievement, Award, etc. (include name of school/organization) Student Role (Captain, Manager, Member, etc) Name of Supervisor/ Coach/ Advisor Phone Number

Please use additional pages if required!

Students Name

Students Signature

Date

Organizational Letters of Reference will be provided by:

(at least one Organization Letter of Reference must be submitted from outside the school community)
Name: Title/Organization:

Phone Number:

Email Address:

Name:

Title/Organization:

Phone Number:

Email Address:

Academic Letter of Reference from a school official will be provided by:

Name: Title:

School:

Phone Number:

I understand that the information submitted in and with this application will be used to assess my eligibility for the scholarship. I certify that all the information provided on this application form and in all the documents accompanying it is true, accurate and complete.

(signature)

(date)

Should I be a successful candidate, I agree to allow my name and photo to be used for publicity purposes.
(signature of student or parent/guardian if student is under 18) (date)

Checklist
Before submitting your application, ensure that it contains four copies of the following documents: A fully completed and signed application form; A typed essay of 250 to 350 words detailing your community involvement; Most recent Credit Counselling Summary or Academic Transcript.

All applications must be received by the Committee by Friday, May 25, 2012. Late or incomplete applications will not be considered. Please retain all originals as these copies of your application materials will not be returned.

J.S. Woodsworth Secondary School Memorial Scholarship Academic Letter of Reference Form 2012
When completed, this form is a confidential report from an academic referee. All forms must be received by the Committee by Friday, May 25, 2012 in order to be considered in support of an application. Referees should complete and mail or deliver both pages of this form in an envelope signed across the seal and addressed to: J.S. Woodsworth Secondary School Memorial Scholarship Committee c/o Merivale High School, 1755 Merivale Road, Ottawa, ON, K2G 1E2
Name of student: Secondary School currently attending: Name of referee:

Please state the length of time you have known the student and in what capacity.

In comparison with others of a similar age, please rank the student in the chart below. If you are unable to comment on any aspect of adjudication listed below for the student, please indicate Inadequate opportunity to observe.
Evaluation Category for Academic Reference Academic ability. Dedication to studies. Academic results. Contribution to school community. Outstanding Top 10% Above Average Next 20% Average Next 20% Below Average Lower 50% Inadequate opportunity to observe

The four JSW Scholarship Criteria are: 1. Student has worked to create a heightened awareness or reduce the impact of injustice and inequality in our community; 2. Student has been actively involved in social issues through a religious, political or other local organization or agency; 3. Student has taken action to better the circumstances of, or heighten awareness about, immigrants, visible minorities or persons with disabilities in our community; 4. Student has demonstrated volunteerism, co-operation, peace-building, leadership and advocacy.

Name of student:

The scholarship will be awarded based on academic performance and the students emulation of four characteristics of the renowned Canadian, J.S. Woodsworth. Please elaborate on the information provided in the assessment grid on the previous page, paying particular attention to any ways in which the applicant has demonstrated the characteristics described in the four JSW criteria. Other relevant comments may be added.

Name of referee: School: E-mail address: Signature:

Title/Position: Phone number:

Date:

J.S. Woodsworth Secondary School Memorial Scholarship Organization Letter of Reference Form 2012
When completed, this form is a confidential report from a supervisory referee whether school-based or community-based. All forms must be received by the Committee by Friday, May 25, 2012 in order to be considered in support of an application. Referees should complete and mail or deliver both pages of this form in an envelope signed across the seal and addressed to: J.S. Woodsworth Secondary School Memorial Scholarship Committee c/o Merivale High School, 1755 Merivale Road, Ottawa, ON, K2G 1E2
Name of student: Secondary School currently attending (if known): Name of referee:

Please state the length of time you have known the student and in what capacity.

In comparison with others of a similar age, please rank the student in the chart below. If you are unable to comment on any aspect of adjudication listed below for the student, please indicate Inadequate opportunity to observe.
Evaluation Category for Organization Reference Outstanding Top 10% Above Average Next 20% Average Next 20% Below Average Lower 50% Inadequate opportunity to observe

Student has worked to create a heightened awareness or reduce the impact of injustice and inequality in our community. Student has been involved in social issues through a religious, political or other local organization or agency. Student has taken action to better the circumstances of, or heighten awareness about, immigrants, visible minorities or persons with disabilities in our community. Student has demonstrated volunteerism, cooperation, peace-building, leadership and advocacy in our community. Consistency of participation in activities supervised by the referee. Level of achievement in activities supervised by the referee.

The four JSW Scholarship Criteria are: 1. Student has worked to create a heightened awareness or reduce the impact of injustice and inequality in our community; 2. Student has been actively involved in social issues through a religious, political or other local organization or agency; 3. Student has taken action to better the circumstances of, or heighten awareness about, immigrants, visible minorities or persons with disabilities in our community; 4. Student has demonstrated volunteerism, co-operation, peace-building, leadership and advocacy.

Name of student:

The scholarship will be awarded based on academic performance and the students emulation of four characteristics of the renowned Canadian, J.S. Woodsworth. Please elaborate on the information provided in the assessment grid on the previous page, paying particular attention to any ways in which the applicant has demonstrated the characteristics described in the four JSW criteria. Other relevant comments may be added.

Name of referee: School: E-mail address: Signature:

Title/Position: Phone number:

Date: