Professional Documents
Culture Documents
Recognizing
ϖ A L T R U IS M ϖ SERVICE ϖ L IF E ϖ
Directors
Website: www.larocca.ca
Email: bursary@larocca.ca
LA ROCCA MEMORIAL SOCIETY
Recognizing
ϖ A L T R U IS M ϖ SERVICE ϖ L IF E ϖ
Website: www.larocca.ca Decisions of the Bursary Award Selection Committee are final, binding and not subject
Email: bursary@larocca.ca to review.
LA ROCCA MEMORIAL SOCIETY
Recognizing
ϖ A L T R U IS M ϖ SERVICE ϖ L IF E ϖ
Website: www.larocca.ca
Email: bursary@larocca.ca
La Rocca Youth Bursary Award
Recognizing
ϖ A L T R U IS M ϖ SERVICE ϖ L IF E ϖ
La Rocca Memorial Society, 9926 Keele Street West, P.O. Box 454, Maple, Ontario, L6A 1S3
Date of Birth:
Email:
Home Telephone:
Mobile Telephone:
Name of School:
Most Recently Completed
Level of Education:
I have included in this application a statement (500 words or less) outlining why I am an ideal
candidate to receive a La Rocca Bursary Award. Yes No
Personal information under the control of the La Rocca Memorial Society shall not, without the consent of the individual to whom it
relates, be used except: (a) for the purpose for which the information was obtained or compiled by the La Rocca Memorial Society; or (b)
for a use consistent with that purpose. By completing and authorizing this Application, you consent to the use of your personal information
for: (a) processing of the application; (b) publication in La Rocca Memorial Society publications; and (c) publication in the media.
Applicant Declaration
I hereby certify that all information is accurate and can be verified upon request; and that I have not been a recipient of this bursary
previously. I hereby acknowledge and agree to the above privacy statements and use of my personal information by the La Rocca
Memorial Society.