LT SCHOLARSHIP PERSONAL INFORMATION

Surname ; Akbar Given Names: Khadija

Street Address 1235 157 B street Cloverdale

City: Surrey Province: British Columbia

Postal Code V3S0Z1 Phone 604-123-456

Email address notmyemail@gmail.com

Date of Birth 2001/07/01 (Day/Month/Year) SIN: 333-444-555

Next of Kin: Zareen Naqvi Relationship: Mother

Street Address: 1235 157 B street Cloverdale
City: Surrey Province: British Columbia Postal Code:
V3S0Z1 Phone: 604-222-333

Do you have sibling? List their gender and age

No

Are One or Both Parents employed? (Circle)

Father’s Employer Kwantlen Polytechnic University
Mother’s Employer Simon Fraser University
Address: Kwantlen- 12666 72 Avenue
Address: Simon Fraser university- 8888 University Dr, Burnaby
Yearly Salary Dad: $90,000 Yearly Salary Mom: $140,000

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Is your family able to contribute to your education costs or living expense? YES or NO
If NO, briefly explain

Will you Graduate High School in June? I will graduate June of 2019
Name Lord Tweedsmuir Secondary school
Location Cloverdale
Street Address: 6151 180 street
City: Surrey

Province: British Columbia Postal Code: V3S 4L5

Phone: 604-574-7407

Are you Employed? YES or NO

If YES, how long Company Name
Supervisors Name Phone number
Street Address:
City: Province:
Postal Code:

Did you Volunteer? YES or NO

If YES, list Year, Organization and Supervisor.(Insert additional page(s) if required)
Year Organization Supervisor
2017 SFU Camps Heidi Yeung

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Did you play Sports in the Community? YES or NO

If YES, list Year, Organization and Supervisor.(Insert additional page(s) if required)
Year Team Coach
2018 Coastal FC Colin Bethune
2017 Guildford Athletic Club Soccer team Randy Samuel

Did you play Sports on a School Team? YES or NO

If YES, List year, Team and Supervisor. (Insert additional page(s) if required)
Year Team Coach
2015 Girls Soccer team

Did you belong to any Clubs or Organizations? YES or NO

If YES, list Year, Organization and Supervisor. (Insert additional page(s) if required)
Year Club/Organization Supervisor

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Did you belong to any Fine Art Clubs (Music, Art or Dance) or Organizations ? YES or NO
If YES, list Year, Organization and Supervisor. (Insert additional page(s) if required)
Year Type/Club/Organization Teacher

What Awards/Certificates have you Won? (Insert additional page(s) if required)

Year Award/Certificates
2013 Certified Red Cross Baby sitter
2015 Super G award
2017 Super G award

List your Hobbies and General Interests? (Insert additional page(s) if required)

Sports; I play soccer and I’m a long distance runner. I have ran in the sun run twice, first time 3k
second time 10k. Hobbies include singing, volunteering, cooking, reading, writing and running.

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What Post-Secondary Program are you enrolling in:

Program Arts or Business
Institution Simon Fraser University
Location Burnaby

Is your program leading towards a: Certificate Diploma Degree

How long is your program? (1 year equals 8 months of full time studies) 4 years
When will you start your program? September 2019

As briefly as possible indicate to the committee your goals and aspirations upon completion of
your studies.(Insert additional page(s) if required)

My aspirations after I have completed my bachelor’s degree is to continue my education and

attend law school. I would like to work at a law firm or even open up my own business. My goal
is to be a lawyer, who devotes her life to helping others get the justice they deserve. I would like
to attend Simon Fraser University for my bachelor’s degree and then go outside the province for
law school.

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Expenses: What do you estimate your following expenses will be?

a) Tuition 25,000
b) Text Books 2,000
c) Other Academic Supplies 1,000
d) Accommodation 6,000
e) Food 2,000
f) Transportation compass card
g) Other (Identify)