You are on page 1of 1


The London Life Academic Award in Business Studies will be presented to a full time student within the
Lawrence Kinlin School of Business at Fanshawe College.
By August 31, 2011, the recipient of this award must have completed Levels 1 and 2 of their School of
Business and Management post-secondary diploma program of study with a minimum 3.5 GPA and no
failures or withdrawals. The recipient must return to Level 3 of his or her program, or be on co-op placement
in September 2011.

The recipient will be chosen on the basis of academic achievement, community involvement and leadership.
Only recent community involvement and leadership roles will be considered. Award recipients will be
recognized at the annual awards ceremony, held in November.
Application forms must be returned to the Awards and Scholarships Office, London Campus, Room K1003, by
Friday July 29, 2011.
Incomplete applications will not be accepted. Please complete application in ink.

Name: Student Number:

Address: S.I.N.:

City & Province: Postal Code:

Phone: Date of Birth:

Program of Study:

FOL Email Address:


1. Please outline all of your community involvement within the past three years (list organization,
your role, and start/end dates)
2. Please outline any community or education related leadership roles you have undertaken within
the past three years (list organization, your role, and start/end dates)

Release of Information Waiver

The information on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act,
2002, Ontario Regulation 34/03; the Financial Administration Act, R.S.O. 1990, c. F. 12, as amended; the Canada Student
Financial Assistance Act, S. C. 1994, c. 28, as amended; and the Canada Student Financial Assistance Regulations, SOR 95-
329, as amended and the Budget Implementation S.C. 1998, c.21 for proper administration of the Ontario Student Assistance
Program, Canada Millennium Scholarship Foundation General Awards, plus procedures for the proper administration of funds
designated for financial assistance/awards to Fanshawe College Students. The information is used for the administration and
statistical purposes of the College and/or the ministries and agencies of the Government of Ontario and the Government of
Canada and/or private donors to include the determination of eligibility for assistance. For further information please contact the
Manager, Awards and Scholarships, Fanshawe College, P.O. Box 7005, London, Ontario, N5Y 5R6, telephone (519) 452-4466.
I have read the declaration and information waiver and hereby authorize the release of information contained herein to the
aforementioned, access to my admission records, and, if a recipient of an award, the release of my name, address, program
information and likeness to the donor. I understand that if this application is not complete in all areas and all supporting
documentation attached, my application will be automatically denied.

Student’s Signature Date

Dec 10