VICTORIA DIOCESAN CATHOLIC WOMEN’S LEAGUE BURSARY,

“In Memory of Freda Smith” ($750)

APPLICATION FORM 

Student’s Name: ______________________________________________________                             

Home Address: ____________________________________________________                             

________________________________________________________             ______________

(Postal Code)                 ___                              

Email Address:          Phone Number: ( )________________________

Mailing Address: (while at school, if different) __________________                            

____________________ 

Name of School___________________________________                         

School Address____________________________________________________

(Postal Code)________    ____ 

Father’s Name ______________________                        __

Mother’s Name ______________________  ______

Family Combined Income Range: (Check one) ___$20,000 to $40,000;____$40,000 to $60,000; 

_____$60,000 to $80,000; ____$80,000 to $100,000  $100,000+

List ages of dependent children (including student)_______________________                                  

_____________________________________________________________________________        

_____________________________________________________________________________ 

Parish Church (participating at)____________________________________________________

Signature of Parish Pastor_________________________________________________________ 

Signature of Parent(s)Father_____________________              __  Mother______                                                                                                                               Date________________________ 

Please Attach:          

  1. A transcript of your Secondary School marks to date.

  2. A Narrative Essay telling us about yourself…(Composition: make it interesting. This will tell us about you. Tell us about your family, your interests, your successes, your parish and community involvement and your future goals.) Send completed form to:

Mrs. Laurel Phyall, 138 Engles Rd.,

Campbell River, BC V9H 1J8/

lphyall@shaw.ca /250-923-6477

(Revised January 2022)