ࡱ> DFC'` bjbj{P{P *2::FFFFFFF %%%%%D-%%%%%W'W'W'-------$9.h0(-F)5'"W'))(-FF%%9=-***)F%F%-*)-**r.,TFF,%% pw?%*.,,S-0-,%1<*%1,%1F,PW'h'J* (<E(W'W'W'(-(-*W'W'W'-))))%%ZT6FFFFFF ADHESIVE & SEALANTS MANUFACTURERS ASSOCIATION OF CANADA SCHOLARSHIP PROGRAM APPLICATION FORM  GENERAL INFORMATION FOR APPLICANTS Applications should be completed with supporting documentation, in duplicate, and forwarded no later than June 1 2010, to the following address: ASMAC., P.O. Box 296 Station A Etobicoke, ON M9C 4V3 Attention: ASMAC Manager All applications received will be acknowledged by ASMAC. The parent or guardian of the applicant must have been an employee of a member of ASMAC for a minimum of one year in order for the applicant to qualify. The successful applicant will be advised of the scholarship award by the ASMAC President SECTION ONE: General Information 1. Full name: (Surname) (First name, or commonly used name) 2. Permanent address: (Street) (Apt#) (City) (Province) (Postal Code) (Area Code & Telephone Number) 3. Name and address of parent or legally appointed guardian: 4. Relationship to the applicant: Year and Month in which parent or guardian commenced employment with the ASMAC member. Please indicate the name of the ASMAC Member Company. ____________________________________________________________________________ SECTION TWO: Educational Background List in chronological order the secondary schools you have attended, including the one you attended most recently: Dates Grades Name of School Address Telephone From: To: Completed List any diplomas earned (i.e. night school courses, conservatory of music, etc.) if any, and name the granting educational institution a) b) c) In the space below, please provide a record of marks, grades and/or letters earned in the last two years of secondary school attended by the applicant. Supporting documents including the transcript of marks, letters of support, and any other material should be originals (all original documents will be returned to the applicant once the selection process is completed) 2009 Year End and General Average: 2010 General Average to date: SECTION THREE: Additional Information Briefly list clubs and organizations within the school in which the applicant participated. Please indicate dates of participation and any offices held (if more space is needed, please attach an additional sheet) a) b) c) Briefly list any involvement in community groups outside school and/or contribution to the life of the community. Please indicate dates of participation and any offices held. (if more space is needed, please attach an additional sheet) a) b) c) SECTION FOUR: Educational Plans Name and address of university or college to which the applicant has been admitted: Name of program to be studied: Name of diploma or degree to be earned: Commencement date of college or university program: Number of years normally required to complete this degree/diploma: Make a brief statement or summary of your plans as they relate to your educational and career objectives and long-term goals __________________________________________________________________________________ SECTION FOUR: Financial Information PARENTAL INFORMATION FATHER Occupation _____________________________________________ Gross Income Survey: 2008 2009 Estimated 2010 MOTHER Occupation ________________________________________________ Gross Income Survey: 2008 2009 Estimated 2010 STUDENT INFORMATION Gross Income Survey 2008____________2009_____________Estimated 2010____________ Other Scholarships or Bursaries awarded for 2010____________________________________ Value of Scholarships or Bursaries Awarded for 2010 _________________________________ Date Signature of Applicant 89^_`c / 0 9 : G H O ] j    D G + 7 N Q R ]     " I P վվթդՠՠդդդդդդդդŠh ;s hN;>* hN;5>* h_Bhvd~ h_Bhr h_BhN;hrh=ghvd~h2hN;jhN;5UmHnHu hN;5 hN;5CJ hN;CJ hrCJ<9M^_abc  # 0 : H P Q k l m n ^ & F$a$$a$ D E F G   ( ) * 7 N O P Q ^ ` & F         # $ % & ' Q R S T U gd_B & Fgdr 1 4 W Smp  #/sWXZĹᱪե h|>* h|h|h|hS&h}AhN;56>*h}AhN;56 h=g56 hN;>* hN;5>*hN; h ;s>*h_Bhrh ;sh}Ah ;s56> 2 3 X Y Z *+,89:FGHTU` & Fh`hgd ;s   + & F^ & Fh^h & F#0sYZ h^hgd|h&d (d P R ^hh$d &d N P ^h & Fgd| & Fh^hZ[%&*+A h^hgd|gdS&gdS& h^hgdS&gd|Z[~$&,?@QUVYjwxy)CDX]^`tTrst¸±¦±¦¦±±¦±¸±¸¸¢ hS&h| h|>*h|h}AhS&56>* h=g56h}Ah ;s56h}AhS&56hS&hS&>* hS&>* hS&hS&hS&hS&5 hS&5>*hS&hS&5>* h|5>*6gdS&(/ =!"#$% 8@8 Normal_HmH sH tH 8@8 Heading 1$@&5:@: Heading 2$@&5>*DAD Default Paragraph FontViV  Table Normal :V 44 la (k@(No List 2B@2 Body Text>*2!z!z!z!z z4 !$'}9M^_abc#0:HPQklmnDEFG()*7NOPQ^#$%&'QRSTU2XYZ*+,89:FGHTU  + # 0 s      Y Z [  %&*+A!!!!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!҅!b!h;!҅!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:!v:9M^_abc#0:HPQklmnDEFG()*7NOPQ^#$%&'QRSTU23XYZ*+,89:FGHTU  + # 0 s      Y Z [  %&*+A000000000c0c 0c0c0c0c0c0c0c0c0c0c0c0c 0c0c0c0c0c 0c0c0c0c 0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c 0c0c0c0c0c0c0c0c 0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c0c 0c0c0c0c0c0c0c0c 0c0c0c0c0c0c0c0c 0c0c0c0c 0c0c0c0c00 0 0  0 0  0 0  0 0  0 0 0 0 0  0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 00 0 0 0000 0 0 0 @0 0  Z  Z8 @(  VB  C D"B S  ?_R""Rt!| !^ !| ! !#!!g"!22##::E88+/CGG;4*urn:schemas-microsoft-com:office:smarttagsaddress92*urn:schemas-microsoft-com:office:smarttagsplace81*urn:schemas-microsoft-com:office:smarttagsCity:3*urn:schemas-microsoft-com:office:smarttagsStreet90*urn:schemas-microsoft-com:office:smarttagsStateB*urn:schemas-microsoft-com:office:smarttagscountry-region P@ptA:::n'UZ &+AptD  v- RSL S hh^h`.hh^h`.hh^h`.hh^h`.v-D RSLS S& 0N;}A_B ;svd~ F~2r=gZ|@tt ߡMMtt@@UnknownGz Times New Roman5Symbol3& z Arial"hTfTf&FF">4 3qHX(?~2NACAN PRODUCTS LIMITEDclunel01James Northover    Oh+'0  $0 P \ h tNACAN PRODUCTS LIMITED clunel01 Normal.dotJames Northover2Microsoft Office Word@G@v+L@X-@X-F՜.+,0 hp  Nacan Products Limited' NACAN PRODUCTS LIMITED Title  !"#$%&'()*+,-./012456789:<=>?@ABERoot Entry FpY ?G1TableA1WordDocument*2SummaryInformation(3DocumentSummaryInformation8;CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q