Online Application Form - Second Chance Scholarship Foundation

Second Chance Scholarship Foundation Inc. is an organization devoted to providing assistance to youth who have come in conflict with the law or are at-risk for such and who show strong promise and potential for completing post-secondary school education.

Name of Applicant *

Email *

Telephone Number

Name of referring Agency / Organization

Name of individual completing referral

Address of referring Agency / organization

Telephone Number of individual completing referral

E-mail address of individual completing referral

Date Referral completed

How could Second Chance assist this youth in achieving his/her goal of completing post secondary school education?

Books

Approximate Cost

Tuition

Approximate Cost

Transportation (Please specify & Approximate Cost)

Academic:

a) Post-secondary institution to be attended & Field of study in which youth interested

b) Level of education completed

c) Currently enrolled in post secondary school studies

Yes
No

d) If currently enrolled in post secondary school studies, provide brief summary of such; e.g. attending full time; study by correspondence; commencement date of program; length of academic program; year of program in which youth is enrolled)

e) If not currently enrolled please provide details as to such; (e.g. commencement date of program; attendance will be full time/part time; study by correspondence; length of academic program; year of program in which youth will be enrolled)

f) Date funding / assistance required

g) In your opinion does this youth have the capacity and motivation to complete the post secondary school academic program in which they are interested? On what basis is this opinion formed?

h) Secondary school grades

Poor
Average
Good
Excellent

Current Status Of Custodial Disposition:

Youth currently in a secure custody facility

Yes

Youth currently in an open custody facility

Yes

Youth currently on

Probation
Community Supervision

General Non-Identifying Information:

Level of motivation/ commitment to completing post secondary school education

Poor
Average
Good
Excellent

Please include general comments/observations on this youth’s support in the community including quality of relationships with individuals providing encouragement/support.

Level Of Responsibility:

Any other comments you wish to offer which would assist the Second Chance Scholarship Foundation in their consideration of this referral:

Applicant’s Comments

*Please have youth complete “Applicant’s Comments” form below and attach.

Second Chance Scholarship Foundation Inc. recognizes that this record may contain information about a young person which is defined by and subject to the Youth Criminal Justice Act. As such, Second Chance Scholarship Foundation Inc. recognizes that all use of information about the young person is subject to publication, use and access restrictions set out in the Act to protect the privacy of the young person.

1. Why do you wish to pursue post secondary school education?

2. Why are you interested in the field of study you have chosen to pursue?

3. Why do you think you should receive assistance from the Second Chance Scholarship Foundation?

4. What does completion of Post Secondary School studies mean for you?

5. Why is successful completion of post secondary school studies important?

6. What have you found most difficult in your post secondary school studies to date?

7. How does your family, friends, girlfriend/boyfriend, spouse feel about you attending post secondary school?

8. Briefly describe where you see yourself in 5 years? In 20 years?

For any inquiries pertaining to this application, please contact Rick Gosling at rickgosling@breakfastclubs.ca. Please submit any additonal questions or information below:

Attach File

Drag & Drop Files, Choose Files to Upload