^{HANS HANSMA CANADIAN YOUTH SCHOLARSHIP APPLICATION}

^{Criteria for Application:}

^{(A) the applicant must be a Canadian Citizen.}

^{(B) The applicant must have come from an active cutting family, or have an active involvement with horses.}

^{(C) The applicant must provide a transcript showing most recent grades.}

^{(D) The applicant must have made the first application by the age of nineteen (19) years.}

^{(E) A recent 3 x 5 photograph must be submitted with the application and include only the head and shoulders of the applicant. Photos will not be returned.}

^{(F) Award of funding is subject to acceptance at a post-secondary educational Institution.}

^{(G) Applications must be received no later than August 15 of the year in which the applicant wishes to receive funding.}

^{(H) Applicants should list any honours or awards received both academically and in extracurricular activities relating to student government, 4-H, sports, and civic or community service.}

^{(I) Funding will only be awarded for each year of the applicant’s designated course. (Ex: for a four year degree program, the applicant may only receive funding for four years.)}

^REFERENCES:

^{The applicant must submit at least two and not more than four letters of recommendation. These letters must be sent directly to the office of the HHCYSF. Required letters include one letter from a CCHA Affiliate Director and one letter from a High School Principal, teacher, counselor or employer. Additional sourced could be 4-H, civic, sports, or community leaders, etc.}

^{Applications should be sent to: HANS HANSMA CANADIAN YOUTH SCHOLARSHIP FUND.}

^{c/o Brenda Batty}

^{9151 Kalamalka Rd.}

^{Coldstream, BC V1B 3C4}

^{Phone (250) 542-6289}

^{Fax: (250) 545-2689}

^{HANS HANSMA CANADIAN YOUTH SCHOLARSHIP FUND APPLICATION}

^{Personal Information:}

^{Name:_________________________________Permanent Address:___________________________________________________}

^{____________________________________ Telephone Number ( ) ______________ Birthday(DD/MM/YY)_______________}

^{Academic Information:}

^{Please list name of post- secondary institution you are attending, or will be attending:}

^{__________________________________________________________________________________________________________}

^{Location:______________________________________________Program Name:_______________________________________}

^{Type of Program Degree______________ Diploma___________ Certificate__________________}

^{Length of Program: _______1 year _______2 years ________3 years ________4 years}

^{Current year of study: _________ Tuition per semester $_____________ Number of semesters attended per year____________}

^{Approximate Cost of books per semester: $___________________ Cost of rent per month $___________________}

^{Name of last High School Attended:____________________________________________________________________________}

^{Dates Attended:_______________________________ Highest grade awarded:_________________________________________}

^{Extracurricular Activities:}

^{Year joined CCHA (or any family member):__________ Last year of membership:________________________}

^{List any CCHA Affiliate you were a member of during the last two years: ____________________________________________}

^{_______________________________________________________________________________________________________}

^{Please list any personal achievements and contributions towards the betterment of the CCHA and CCHA Youth.}

^{If more space is required, please attach additional sheets._________________________________________________________}

^{_______________________________________________________________________________________________________}

^{_______________________________________________________________________________________________________}

^{List any extracurricular activities you partook in, including Student Government, 4-H, Sports, or Community Service:}

^{_______________________________________________________________________________________________________}

^{List any honours or awards you have received:__________________________________________________________________}

^{Family Information: Fathers Name:________________________Occupation:_____________________________}

^{Mothers Name________________________Occupation:_____________________________}

^{If parents address is the same as yours above, continue, however if it is different, please list:}

^{_______________________________________________________________________________________________________}

^{Number of children in family:________ In High School:_______________ In college/University:_________________________}

^{Applications must be received no later than August 15th of the year in which the applicant wishes to receive funding.}

^{__________________________________________________ ________________________________________________}

^{Signature of Applicant Date}