Victoria Italian Assistance Centre Scholarship Application

Please print off, fill out this form, and send the completed application to:

*Please note that the application must have supporting documents post-dated no later than June 15 of the application year.*

Given Name

Last Name

Preferred Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary School

Post-Secondary Institution

Full name of parent or grandparent with Italian citizenship

I hereby apply for the $1,200 Victoria Assistance Centre Scholarship. Please find enclosed:

A certified copy of Grade 11 and 12 transcripts (to date). This will be weighted at 25% for the selection criteria.
A 500-word essay detailing what your Italian heritage means to you. This will be weighted at 50% for the selection criteria.
A letter of reference from a school administrator, counselor, or teacher. This will be weighted at 25% for the selection criteria.

I confirm that:

I have at least one parent or grandparent with Italian citizenship YES NO
If I am awarded the Scholarship, I agree to allow my photograph and biographical information to be distributed and publicised by the Victoria Italian Assistance Centre.

Date: Signature:

rentalmanager@davincicentre.ca