Saltfleet District High School

Scholarship Profile
Name:_______________________________

Email this form to msusi@hwdsb.on.ca or submit a hard copy to the guidance office as soon as possible

Total average from grade 11 %

(overall)

Total Number of Volunteer Hours (to date)

Universities/Colleges of Interest Program of interest

1.

2.

3.

Extracurricular Activities
Activity Year(s)/Grade Describe any Leadership Role
School extra-curricular
i.e. sports, clubs, students
council, etc

Community extra-
curricular
i.e. volunteer work, clubs,
sports, Worship, etc.
Employment

Awards/Certifications/
Qualifications

Please check if you:

□ have Aboriginal status in Canada □ have an exceptional identification on your IEP

□ are of Caribbean descent □ could speak to overcoming personal adversity

□ commit to any environmental initiatives □ have a total family income less than $50,000/year

Financial Need (highlight one): Low Medium High Extremely High

Please provide a brief explanation of financial situation if applicable:

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Any additional information that may influence your application:

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