WCRC Legacy Scholarship Application Form Scholarship Application Applicant Information First Name * Last Name * Address: * Address: Address: Address: City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone Number * Email Address * Consent PRIVACY CONDITIONS: Please note these conditions before submitting this application: The information provided in this application is true, accurate, and complete. I am aware that providing incomplete or false information will render my application null and void and will not permit me to compete for this scholarship. I authorize Ringette Calgary to verify student information included to determine eligibility. I authorize the Selection Committee to access my playing, coaching and officiating history as required. I authorize Ringette Calgary to make copies of this application and distribute it to the Selection Committee for the purpose of review. No applicant names will be included in this process. Privacy: * I understand the Privacy Conditions CONSENT FOR PUBLIC RECOGNITION: Checking yes on this consent form permits Ringette Calgary to publicly recognize your achievement as a recipient of the scholarship. If selected for this scholarship, consent is given to Ringette Calgary to publish the student’s name, school location, and scholarship received. It is understood that not agreeing to this consent will not prejudice the consideration of student scholarship applications. Consent * YES, I consent to public recognition NO, I do not consent to public recognition Academic Name of Canadian Post-Secondary Institution currently attending: * City * Province * Field of Study: * Ringette Playing Experience Use a separate line for each season. Season Team Division City plus1 Add minus1 Remove Coaching Certfication Coaching Certification Respect In Sport CI CSI Ringette Coaching Experience Season Team Division Position Head CoachAssistant CoachOn-Ice HelperJunior Coach plus1 Add minus1 Remove Ringette Officiating Certification Level # Years as an Active Official Ringette Committee Experience Do you have any experience sitting on Ringette boards or committees? Season Position Committee Association plus1 Add minus1 Remove Ringette Work Experience Please list any Ringette experiences where you received payment for your duties. ie. Ringette Schools. Use a separate line for each year you may have worked at the same task. Month/Year Task Commitment: < 5 hrs5-10 hrs11-20 hrs> 20 hrs Worked For: plus1 Add minus1 Remove Other Ringette Volunteer Experience Can include on ice assistance, evaluating, tryouts, clinics, etc. Use a separate line for each year you may have volunteered at the same task. Month/Year Task Commitment: < 5 hrs5-10 hrs11-20 hrs> 20 hrs Volunteered For: plus1 Add minus1 Remove Other Volunteer Experience Can include community, school, events, etc. Use a separate line for each year you may have volunteered at the same task. Month/Year Task Commitment: < 5 hrs5-10 hrs11-20 hrs> 20 hrs Volunteered For: plus1 Add minus1 Remove Have you ever been assessed a Misconduct Penalty? * No Yes How many Misconducts have you received? Have you ever been assessed a Match Penalty? * No Yes How many Matches have you received? In a few words, please tell us how Ringette has impacted your personal development. * Your Proof of Enrollment * Drop a file here or click to upload Choose File Maximum file size: 25MB Provide proof of enrollment at a Canadian Post-Secondary Institution. After you hit submit your file will be uploaded and you will receive an on screen confirmation that we have received your application. You will also receive an email confirming this. Captcha If you are human, leave this field blank. Δ
