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 Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe 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 Add Remove Coaching Certfication Coaching Certification Respect In Sport CI CSI Ringette Coaching Experience Season Team Division Position Head Coach Assistant Coach On-Ice Helper Junior Coach Add 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 Add 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 hrs 5-10 hrs 11-20 hrs > 20 hrs Worked For: Add 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 hrs 5-10 hrs 11-20 hrs > 20 hrs Volunteered For: Add 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 hrs 5-10 hrs 11-20 hrs > 20 hrs Volunteered For: Add 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 upload size: 10.49MB 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. reCAPTCHA Δ
