THE LEONARD FOUNDATION FINANCIAL ASSISTANCE PROGRAM
A Private Scholarship Trust Established in 1916 by the late Rueben Wells Leonard (1860-1930)

APPLICATION FORM

Before completing this application, please read item 6 on the Criteria page regarding maximum total annual gross income as found on our website at www.leonardfnd.org.

Section 1 – To be completed by the Applicant

Official name of College/University you expect to be attending in September
Name:
Last Name	Given Name(s)
Permanent Address:
Date of Birth:
Street Number & Name	Apt/Unit #	(Day Month Year)
Telephone:
City	Province
eMail:
Postal Code

Have you ever received a Leonard Foundation Award before?	Yes No
If “YES”, in what year and what amount $
Is either of your parents in the “preference” group as defined by the Criteria page at www.leonardfnd.org? If “YES”, select from the following categories.	Yes No
Ordained Clergy	Member of Engineering Institute	Canadian Military
School Teacher	Member of Mining & Metallurigal Institute of Canada	Canadian Military College Graduate
In what program do you expect to enroll this coming September?
Year	1st, 2nd, etc.
List any degrees you will have by next September:

TRANSCRIPTS – Copies of transcripts for all post secondary courses completed at the time of submitting this application are required. Do not submit secondary school transcripts.

Section 1 (cont’d)

Describe any physical or athletic activities in which you participate:
Describe any extra curricular activities in which you currently participate:
Describe any Armed Forces training, if any:
State the reasons you believe you qualify for the Leonard Foundation’s financial assistance.

Financial Information

Funding for this current academic year: List all scholarships, bursaries, grants, loans (including provincial student aid loans) you received this year and the value of each
TOTAL VALUE	$
Funding for next academic year: List all scholarships, bursaries, grants, loans (including provincial student aid loans) for which you have applied or plan to apply for the next academic year and the estimated values of each.
TOTAL VALUE	$

Section 1 (cont’d)

Your income – from full and part time jobs
Enter your gross earnings from last June to this coming May	$
Enter the amount of any other income received from any other source during this same period.	$
Enter the amount you anticipate earning from this coming June to May of next year, e.g. from summer employment or part-time work during the school year.	$
Estimate your expenses for the upcoming Academic year commencing this September.
Tuition Fees	Books	Residence	Other	Total Expenses
Will you be required to take of a temporary residence to attend university?	Yes No
Independent Applicants – To qualify as an “independent” applicant, you must be permanently domiciled outside of the family home for a number of years and receive no financial support, for living and education expenses from that family. You are required to declare your status, income and assets as well as the status of anyone with whom you may have a partnership. You must provide sufficient detail to justify your financial need. It is recommended that you attach a detailed budget for the next academic year including all revenues and expenses. Please attach a detailed budget for the next academic year including all revenues and expenses.
Declaration of Applicant I hereby certify that all the information provided in Section 1 of the Application to be true, correct and complete in all respects.
Date (dd-MMM-yyyy)	Signature*

*An electronic signature will be accepted if this application is completed and sent electronically

Section 2

To be completed by parent(s) or guardian(s).

First Parent/Guardian

Note: You may be required to provide official documentation that supports your statement of family income (e.g. most recent Canada Revenue Agency, Notice of Assessment).

Name:
Relationship:
Occupation:
Gross annual income from all sources;	$
Value of any other benefits received in lieu of a salary, such as a car allowance, housing subsidy, clothing allowance, if any:	$

Second Parent/Guardian*

Name:
Relationship:
Occupation:
Gross annual income from all sources;	$
Value of any other benefits received in lieu of a salary, such as a car allowance, housing subsidy, clothing allowance, if any:	$

*If only one parent’s or guardian’s income is revealed, please explain why.

I hereby certify that the information provided in Section 2 of this Application to be true, correct and complete in all respects.
Date	Signature *

*An electronic signature will be accepted if this application is completed electronically.

Section 3

Conduct Certificate: To be completed by someone who has known you for at least two (2) years, such as a teacher, member of the clergy, professor or principal who is not related to you.

I	certify that I have known the Applicant as a person of
good character and conduct and one likely to justify selection for an award from The Leonard foundation and, to my knowledge, needs financial assistance in order to continue her/his education.

Please explain how you know the applicant and any further remarks you would like to make:

Occupation:	Telephone:
Address:
Date (dd-MMM-yyyy)	Signature*

*An electronic signature will be accepted if this application is completed and sent electronically

NOTE TO APPLICANT:

If you do not receive correspondence from the Foundation by May 31, it will be because you were not chosen to receive an award.