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# №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdЖнVJФНЖнVZ№ h–№4Ђ №" C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№–бdpЩТq‰ŽэзZ№ h—Z №  №4Ђ №# C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№Џсd]oУJФНбЊШZ№ h˜Z №  №4Ђ №$ C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№|ŒpЩЮМ\ЗЯZ№ h™Z №  №јB №% # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdpЩJФНpЩZ№ hš№јB №& # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdџф`JФНџф`Z№ h›№јB №' # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdЦ‚ПJФНЦ‚ПZ№ hœ№Ќ№^ №iј\‡KxХŽэз №MZ№ y­Ыџ  <Кџ ˆR4 žЂFZ№ hz№@ № s №œLџрŽ‚рŽƒрŽ„рŽЅъAСƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПDD00372_ѓ"ёZ?@П џ@@@B€‚РТ@Bџ№iј\‡KBн`PзZ№ hA№: № c №–рŽ‚рŽƒрŽ„рŽкэAСƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПDD00372_ѓ"ёZ?@П џ@@@B€‚РТ@Bџ№žИС‡KxХPзZ№ hD№4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№–бdЎZZJФН›NФZ№ hGZ №  №4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№`u`‡KсАСёRZ№ hIZ №  №јB № # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdёRJФНёRZ№ hJ№4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№рD˜MiЪ хМŽэзZ№ hSZ №  №4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№–бd82ЫЂe—ŽэзZ№ hTZ №  №јB № # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdMiЪJФНMiЪZ№ hd№јB №  # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdp{YJФНp{YZ№ h[№јB №  # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№5AeќоУщ3ОќоУZ№ hc№4Ђ №  C №x€(c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№`u`ёRсАСp{YZ№ h;Z №  (№4Ђ №  C №x€,c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№рD˜ќоУЋTН‹HЫZ№ hLZ №  ,№LЂ №? C №x€4c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПC"ёxЦ@@П џ``@B €‚П РТџ ? @BK№–бdќоУрD˜‹HЫZ№ hZ №  4№:№^ №iј\‡KxХ/ж №NZ№ y­Ыџ  <Кџ ˆR4 "фDZ№ hq№@ № s №œLџрŽ‚рŽƒрŽ„рŽЅъAСƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПDD00372_ѓ"ёZ?@П џ@@@B€‚РТ@Bџ№iј\‡KBн`авдZ№ h{№: № c №–рŽ‚рŽƒрŽ„рŽкэAСƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПDD00372_ѓ"ёZ?@П џ@@@B€‚РТ@Bџ№žИС‡KxХавдZ№ h~№4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№–бd*\JФНЦ‚ПZ№ hZ №  №4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№–бd2;ШТq‰/жZ№ h…Z №  №4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№–бdBAС1ДНЖ|ЦZ№ h†Z №  №4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№|ŒpЩЮМмвбZ№ h‡Z №  №јB № # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бd*ИЫJФН*ИЫZ№ hˆ№Њ№f №џф`ёRсАСhј\ №A# № ˆ№žTaЖнV€ Тџф`Z№ h№4Ђ № C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆП"ё`Ц@@П џ@@@B€‚РТ@BK№џф`О`SсАСhј\Z№ h‚Z №  №јB № # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdёRJФНёRZ№ h„№јB № # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бd*\JФН*\Z№ h‰№јB № # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆПГ"ёBП @B€‚РТ@B№–бdˆЃОJФНˆЃОZ№ hŠ№LЂ №8 C №x€.c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПC"ёxЦ@@П џ``@B €‚П РТџ ? @BK№`u``u`сАСXђcZ№ hRZ №  .№LЂ №@ C №x€6c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆПC"ёxЦ@@П џ``@B €‚П РТџ ? @BK№`u`‡KсАСЖнVZ№ hZ №  6№p№^ №iј\‡KxХŽэз №LZ№ y­Ыџ  <Кџ ˆR4 žЂFZ№ h№@ №* s №œLџрŽ‚рŽƒрŽ„рŽЅъAСƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ ПDD00372_ѓ"ёZ?@П џ@@@B€‚РТ@Bџ№iј\‡KBн`авдZ№ hW№: №+ c №–рŽ‚рŽƒрŽ„рŽкэAСƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ ПDD00372_ѓ"ёZ?@П џ@@@B€‚РТ@Bџ№žИС‡KxХавдZ№ h^№4Ђ №, C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ П"ё`Ц@@П џ@@@B€‚РТ@BK№–бd`u`JФНBAСZ№ hoZ №  №4Ђ №- C №x€c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ П"ё`Ц@@П џ@@@B€‚РТ@BK№`u`єМWBAСžTaZ№ hpZ №  №јB №/ # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆ ПГ"ёBП @B€‚РТ@B№їadUMWЋTНUMWZ№ hr№4Ђ №0 C №x€ c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ П"ё`Ц@@П џ@@@B€‚РТ@BK№–бdpЩТq‰ŽэзZ№ hsZ №  №4Ђ №1 C №x€ c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ П"ё`Ц@@П џ@@@B€‚РТ@BK№–бd€ Т1ДНє[ЧZ№ htZ №  №4Ђ №2 C №x€ c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ П"ё`Ц@@П џ@@@B€‚РТ@BK№|ŒpЩЮМ\ЗЯZ№ huZ №  №јB №3 # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆ ПГ"ёBП @B€‚РТ@B№–бdpЩJФНpЩZ№ hv№јB №4 # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆ ПГ"ёBП @B€‚РТ@B№їad`u`ЋTН`u`Z№ hw№јB №5 # №lрŽ‚рŽƒрŽ„рŽƒПРТЫœ1џ„рŽ…рŽ†рŽ‡рŽˆ ПГ"ёBП @B€‚РТ@B№–бdBAСJФНBAСZ№ hx№LЂ №C C №x€8c‚cƒc„cПƒПРТЫџ„рŽ…рŽ†рŽ‡рŽˆ ПC"ёxЦ@@П џ``@B €‚П РТџ ? @BK№`u`‡KсАСЖнVZ№ hMZ №  8CHNKINK ,„ј€TEXTTEXTBSTSHSTSHDSTSHSTSH,DВSTSHSTSHоD<FDPPFDPPFFDPPFDPPHFDPPFDPPJFDPPFDPPLFDPPFDPPNFDPCFDPCPFDPCFDPCRFDPCFDPCTFDPCFDPCVFDPCFDPCXFDPCFDPCZFDPCFDPC\FDPCFDPC^FDPCFDPC`FDPC FDPCb1. Name of Applicant:_________________________________________________________ 2. Present Address: ___________________________________Phone Number:___________ ____________________________________________________________________ 3. Home Address: ____________________________________Phone Number:___________ ____________________________________________________________________ 4. Social Insurance Number: ____________________________ 5. Education: Grade 12 completed at: _______________________________Year _________ Post Secondary Education completed: Course: _________________________________________________ Year _________ Course: _________________________________________________ Year _________ ** Please attach OFFICIAL TRANSCRIPT of marks from your most recent year of study. List employment for the last two years:__________________________________________ _____________________________________________________________________ _____________________________________________________________________ 7. University, technical institute or college to which you have been accepted: _____________________________________________________________________ Program you are enrolled in: ______________________________________________ ** Attach proof of acceptance and/or enrollment Please list the following in point form: a.) Community involvement: ______________________________________________ _____________________________________________________________________ _____________________________________________________________________ b) Leadership roles:______________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Dr. Holmes Scholarship Fund Inc. Mail to: Dr. Holmes Scholarship Fund Inc. Box 285 Eston, SK S0L 1A0 Fax: (306) 962- 4330 l Signature: ________________________________ Date: ______________________ 13/05/2010 Reference Form *Note: References must be three different people Please use back of application forms to elaborate Deadline: September 30 Signature: ________________________________ Date: ______________________ Mail to: Dr. Holmes Scholarship Fund Inc. Box 285 Eston, SK S0L 1A0 Fax: (306) 962- 4330 13/05/2010 Reference Form *Note: References must be three different people Employment reference must be a person in a position of authority, eg. Employer Deadline: September 30 1. Name of Applicant:________________________________________________________ Present Address:___________________________________________________________ State your position of authority in relation to this applicant s employment and how long you have known this applicant. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Please comment on the applicant s performance: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ State any Leadership qualities and/or any other areas in which the applicant has excelled. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 5. Name, address and phone number of person providing this reference (please print). _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Academic Reference Form *Note: References must be three different people Please use back of application forms to elaborate Deadline: September 30 Signature: ________________________________ Date: ______________________ Mail to: Dr. Holmes Scholarship Fund Inc. Box 285 Eston, SK S0L 1A0 Fax: (306) 962- 4330 13/05/2010 Reference Form *Note: References must be three different people Academic reference must be a person in a position of authority, eg. Teacher/Professor Deadline: September 30 1. Name of Applicant:________________________________________________________ Present Address:___________________________________________________________ How long have you known the applicant and in what capacity? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Please comment on the applicant s performance: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ State any Leadership qualities and/or any other areas in which the applicant has excelled. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 5. Name, address and phone number of person providing this reference (please print). _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Reference Form *Note: References must be three different people Please use back of application forms to elaborate Deadline: September 30 Signature: ________________________________ Date: ______________________ Mail to: Dr. Holmes Scholarship Fund Inc. Box 285 Eston, SK S0L 1A0 Fax: (306) 962- 4330 13/05/2010 Dr. Holmes Scholarship Fund Inc. Community Involvement Reference Form *Note: References must be three different people Reference must be a person in a position of authority, eg. Leader/Director Deadline: September 30 1. Name of Applicant:________________________________________________________ Present Address:___________________________________________________________ How long have you known the applicant and in what capacity? _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Please comment on the applicant s performance. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ State any leadership qualities and/or any other areas in which the applicant has excelled. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 5. Name, address and phone number of person providing this reference (please print). _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Application Form Deadline: September 30 Application Form Deadline: September 30 Please use back of application forms to elaborate Dr. Holmes Scholarship Fund Inc. Academic Dr. Holmes Scholarship Fund Inc. Employment t<‘џџџџžt<‘’D† "№$Šhˆˆˆˆˆˆˆ ˆˆ,ˆ9"№DŠ "А0(t<‘џџџџџџџџ must be a person in a position of authority, eg. Leader/Director Deadline: September 30 1. 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