Carolyn Piett Memorial Bursary Application (Embro Minor Hockey)

Carolyn Piett Memorial Bursary Application

Carolyn Piett Bursary Criteria 1. Is entering post secondary education, apprenticeship program or other educational program 2. Has played with the EMHA or West Oxford Inferno hockey teams 3. Is 21 yrs of age or younger as of Dec 31 of the year of application. Please complete this application for the Carolyn Piett Memorial Bursary by May 31st

First and Last Name^*

Required

Please select your date of birth.^*

Required

Phone Number ^*

Required

Email Address^*

Required

Mailing Address^*

Required

Please identify the institution you are attending,^*

Required

Please list each year and level played in the West Oxford Inferno/EMHA.^*

Required

Please provide a summary of what hockey has meant to you and what plans you have to be involved in hockey in the future.^*

Required

Your summary will be limited to 250 words (1500 characters). You can copy and paste from your word processor into this field.

Please scan and attach confirmation of the educational program you are enrolled in (e.g. Tuition receipt, Acceptance Confirmation, etc.)^*

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 2. Maximum File Size: 4MB.

Privacy Act: I consent to Embro Minor Hockey Association (EMHA) collecting and using the personal information provided by me in this application and in any related documentation submitted by me to EMHA for the purposes of administering the Bursary. I acknowledge and agree that my personal information may be disclosed by EMHA to the public for the purpose of promotion of this program.

I agree to the terms and conditions stated above^*

Carolyn Piett Memorial Bursary Application (Embro Minor Hockey)

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