Gloucester-Cumberland Ringette Association Scholarship Application Form

Surname: ________________________ First Name: _____________________

Address: ________________________________________________________

City: ____________________________ Postal Code: ____________________

Email Address: ____________________Telephone Number: ______________

Are you currently a Gloucester-Cumberland resident?    Yes _____ No _____

Did you play ringette for a Gloucester or Cumberland and/or GCRA team in at least four out of
last five years?     Yes _____ No _____

High school attended and grade enrolled as of June 1, 2005:

_______________________________________________________________

Address: ________________________________________________________

City: ____________________________ Postal Code: ____________________

Name of the post-secondary institution you are planning to attend in 2005/06

_______________________________________________________________

Address: ________________________________________________________

City: ____________________________ Postal Code: ____________________

Program you expecting to enroll in ____________________________________