2014 Zajac Foundation Scholarship

APPLICATION FORM



The Zajac Scholarship is awarded annually to a young adult (16-25 years old with a disa!ility that is attending"or planning to attend post
secondary education in #ritish $olu%!ia (credited courses leading to a degree& diplo%a or certi'icate or a structured (ocational progra%

)a%e

*ate o' #irth

First )a%e +ast )a%e ,onth"*ay"-ear
.ddress


/hone )u%!er
)ature o' the *isa!ility




)a%e o' Secondary /rogra%"0ocational /rogra%


.rea o' Studies"Training




0olunteer .cti(ities"$o%%unity /articipation





1e'erence (/lease enclose 2 re'erence letters

)a%e /hone )u%!er 1elationship
13
23
23

PLEASE INCLUDE A LETTER OF 150 200 WORDS EXPLAINING WHY YOU FEEL YOU SHOULD BE AWARDED THE
ZAJAC SCHOLARSHIP.

.pplication deadline is .ugust 24
th
& 20143 Send co%pleted applications to5

Zajac $o%%ittee
c"o #$ $entre 'or .!ility
2605 7ingsway
0ancou(er& #$
051 584

91 e%ail :ason3ca%p!ell;!c-c'a3org