SHL SCHOLARSHIP AWARD

APPLICATION PACKAGE In the 2012-2013 season, the Vic Johnston Community Centre (VJCC) and the Streetsville Hockey League (SHL) announced the creation of the SHL Scholarship Award. These scholarships have been created using the proceeds from the Streetsville Ceilidh, the community fundraising festival held in September of each year. This season a pool of $3000 is available to be awarded to eligible individuals.

SHL SCHOLARSHIP CRITERIA

1 Applicant must have been registered for a cumulative total of five years, including a minimum of three years as a player, with the Streetsville Hockey League (“SHL”).

2 Applicant must be registered with the SHL in the year of application.

3 Applicant must currently be at a position in his or her education to be eligible to attend an accredited post secondary institution.

4 Decision of the Scholarship Committee will be final. There is no appeal process for any applicant(s).

5 Applicant must not be serving a suspension in excess of four games at the date of application.

6 Applicant must not have served more than 20 games of suspension during the applicant's career in the Streetsville Hockey League.

7 Scholarship Committee will assess all applications and forward its recommendation(s) to the Board of Directors of the VJCC for a majority

approval.

8 Applicant will only be eligible to receive this scholarship award once in his or her lifetime.

9 Applicant must submit fully completed application form together with:

a) Two (2) letters of reference from his or her current school (one must be from a teacher). b) One (1) letter of reference from his or her SHL related organization. c) An official copy of his or her high school transcript. d) A letter outlining their contribution to the SHL, and what the game of hockey has meant to him or her.

10 All information must be submitted by April 30th of the year of application in order to be considered for that year’s scholarship awards.

11 Successful applicants will be announced in September, and payment of the scholarship will be issued by October 31st, upon proof of

enrolment. Proof of enrolment will be in the form of an official school document (letter from Registrar) from the accredited post-secondary institution the applicant is attending. Payment will be made directly to the successful applicant(s).

12 Completed application and all required documentation must be forwarded to the Programs Manager, Streetsville Hockey League, PO

Box 632, Streetsville Ontario L5M 2C2, or by email to info@streetsvillehockeyleague.com.

13 Facsimiles will not be accepted.

14 By submitting an application and signing below I hereby irrevocably grant to The Vic Johnston Community Centre, the Streetsville Hockey League, its subsidiaries, affiliates and promotional representatives and agents the right to use my name and photograph submitted into the Streetsville Hockey League Scholarship Program in any media or form including television, online, and print without remuneration, compensation or other obligation, at any time and from time to time for the purpose of advertising, publicity and promotion.

Date Received (internal): SHL Scholarship Application Form [Please print clearly]

1. Personal Information:

Name: (First) (Last)

Address: Unit Number Street Name

City Province Postal Code Home Telephone: [ ] Facsimile: [ ] Email address

2. Hockey Involvement: [Five most recent years] YEAR: Team Name: Involvement: (E.G. Player, Coach, Referee) YEAR: Team Name: Involvement:

YEAR:

Team Name:

Involvement:

YEAR:

Team Name:

Involvement:

YEAR:

Team Name:

Involvement:

3. Education Information:

Current School: Contact: Telephone:

School Address:

Post-Secondary Education Institution Applied For:

Area of Study:

4. Additional Information:

Volunteer: SHL: Other:

Timekeeper:

SHL:

Other:

Referee:

SHL:

Other:

Suspensions:

SHL:

Other:

Volunteer Hours for School (where & when):

I hereby apply for scholarship assistance and declare that all of the information contained in this application is complete and true in every aspect. I have answered all questions applicable to me on this form.

Signature of Applicant

Date

I, the undersigned parent or legal guardian identified below hereby irrevocably grant to The Vic Johnston Community Centre, the Streetsville Hockey League, its subsidiaries, affiliates and promotional representatives and agents the right to use my name and photograph submitted into the Streetsville Hockey League Scholarship Program in any media or form including television, online, and print without remuneration, compensation or other obligation, at any time and from time to time for the purpose of advertising, publicity and promotion.

Print Name and Signature of Parent / Guardian Date