General Information and Policies

MindFuel Scholarships for Post-Secondary STEM (Science, Technology, Engineering, Math) and Science

Education Based Learning Programs

Scholarships are available to students who have graduated from an Alberta high

school and who are entering first year in an undergraduate applied science or

science education program at an Alberta-based post-secondary institution in the

fall 2015.

MindFuel offers three scholarships to students applying to an Alberta-based post-secondary institution. Value: $2,500 - $5,000

Criteria Applicant must be an Alberta high school graduate. Applicant can apply for more than one scholarship, however, upon successful selection, would only be

eligible to receive one scholarship award. Eligibility: Open to students entering first year in an undergraduate science, applied science degree or

science education program at an Alberta-based post-secondary institution in fall 2015. Application: Available January 20, 2015. There is one deadline for the competition:

DEADLINE: May 15, 2015 for entering the College, Polytechnic, or University in the 2015/2016 program year.

Notification: Recipients are notified by phone or email on June 22, 2015. Recipients are not required to accept their award, but must notify MindFuel by June 26, 2015 regarding their acceptance or decline of award.

Registration Requirement(s): Recipients are required to be registered full-time at an Alberta-based post-secondary institution for the fall term by August 15, 2015 and must maintain full-time enrolment through the upcoming fall and winter terms.

Payment: Award funds are sent to the registrar and are automatically applied to outstanding tuition and fees.

1.

2015 Application Form

Important – Application Checklist Before mailing your application, ensure that it

contains all the required documents in the

following order:

1. this application form, fully completed and

signed;

2. your essay of up to 500 words, by you,

describing your interest in STEM (Science,

Technology, Engineering, and Math) or

Science Education based on the scholarship

you are interested in applying for. Tell us:

which of our three scholarships you

are applying for and why.

why you are interested in pursuing a

science or education based learning

program. Why are you passionate

about the program of studies you

are pursuing?

how could you apply your education

in innovative ways?

how STEM has affected you?

3. an original letter of recommendation from

your school, written and signed (electronic

signatures will not be accepted) by a senior

official, such as your principal, guidance

counsellor or teacher;

4. two letters of support or confirmation

written and signed (electronic signatures will

not be accepted) from groups or individuals

(e.g. mentor, volunteer program, employer,

etc.) who have influenced you, and on which

this application is based. If there are

exceptional circumstances where these two

letters cannot be provided, you may include

a letter detailing those special

circumstances;

5. official copy of high school transcript;

6. any additional facts about you that have

not been identified in the outlined

requirements, that you feel we should be

aware of. Please include in written form, in

fewer than 200 words.

2.

No material, other than that listed on this page,

will be presented to the Awards Committee.

Materials cannot be returned. Please retain a copy

of this application for your records.

Applicants selected as award recipients will be

notified by June 22, 2015 by phone or email.

Additional written notification will be sent to

award recipients by June 22, 2015. Scholarships

will be awarded at a ceremony in mid-July.

Applicants who are not awarded a scholarship will

be notified by end of June 2015.

All applications and correspondence should be

sent by registered mail or courier to:

MindFuel Scholarships Program Suite 260, 3512 – 33 Street NW Calgary, Alberta T2L 2A6

Deadline All applications and supporting documents must

be received no later than May 15, 2015. No

applications will be accepted after the deadline

regardless of the postmark date. Please do not

send applications by fax or email, as they will not

be considered. This application MUST be filled out

and sent by MAIL or COURIER.

For more information:

MindFuel

403-220-0077 ext. 238 or

Scholarship@MindFuel.ca

Are you currently completing the final year of high school in Alberta Yes No

Tell Us About Yourself

All fields are required

Ms. Mr.

Citizenship

Canadian Citizen

Permanent Resident

Other (Please Specify)

First Name Middle Name Last Name

Home Address Apt. Telephone

–

–

City Province Postal Code

Email (required in order to confirm receipt of application) Expected date of graduation

Name of High School

M / D / YYYY

School Address Telephone

– –

City Province Postal Code Fax

– –

Any previous high schools attended, by year

Career/Occupational Interests

List up to three careers or occupations you are considering. If you don’t know yet, indicate

“uncertain.”

1.

2.

3.

Educational Intentions After High School

If known, name of educational institution you plan to attend. Type of institution (circle one): Anticipated course of study and degree/diploma sought. Have you received early acceptance?

Anticipated start date. If yes, which school(s) has accepted you?

yes no

University College Polytechnic

3.

Dr. Arlene Ponting Scholarship - $2,500

Anne Tingle Scholarship - $2,500

James (Jim) Gray Scholarship - $5,000

N o t e : T h e s u c c e s s f u l r e c i p i e n t o f t h i s s c h o l a r s h i p m u s t b e e n t e r i n g a n a r e a o f S T E M ( S c i e n c e , T e c h n o l o g y , E n g i n e e r i n g o r M a t h ) r e l a t e d s t u d y a t a n A l b e r t a - b a s e d p o s t -s e c o n d a r y i n s t i t u t i o n .

Must be completed Complete your 500-word essay describing your i n t e r e s t i n i n n o v a t i o n a n d t h e a r e a s o f S T E M ( S c i e n c e , T e c h n o l o g y , E n g i n e e r i n g , a n d M a t h ) . Then, in the space below, SUMMARIZE your most important achievement to date in this area in a few sentences.

N o t e : T h e s u c c e s s f u l r e c i p i e n t o f t h i s s c h o l a r s h i p r e c o g n i z e s a n i n d i v i d u a l w h o i s p a s s i o n a t e a b o u t s c i e n c e a n d w h o i s a c c e p t e d i n t o a n u n d e r g r a d u a t e d e g r e e p r o g r a m i n e i t h e r s c i e n c e o r s c i e n c e e d u c a t i o n a t a n A l b e r t a - b a s e d p o s t - s e c o n d a r y i n s t i t u t i o n . Must be completed Complete your 500-word essay describing your i n t e r e s t i n s c i e n c e o r s c i e n c e e d u c a t i o n . Then, in the space below, SUMMARIZE your most important achievement to date in this area in a few sentences.

N o t e : T h e s u c c e s s f u l r e c i p i e n t o f t h i s s c h o l a r s h i p r e c o g n i z e s a n i n d i v i d u a l w h o i s p a s s i o n a t e a b o u t s c i e n c e a n d t e c h n o l o g y a n d w h o i s a c c e p t e d i n t o a n u n d e r g r a d u a t e d e g r e e p r o g r a m i n e i t h e r s c i e n c e o r t e c h n o l o g y a t a n A l b e r t a -b a s e d p o s t - s e c o n d a r y i n s t i t u t i o n . Must be completed Complete your 500-word essay describing your i n t e r e s t i n s c i e n c e a n d t e c h n o l o g y . T hen, in the space below, SUMMARIZE your most important achievement in this area to date in a few sentences.

4.

List organizations and/or individuals whose letters of support/confirmation, regarding the above, are enclosed with this application.

Name of Individual Organization Daytime Phone Number

1.

2.

List name and title of senior official from your school whose letter of recommendation is enclosed with this application.

Name Title School

Extracurricular Activities

List extracurricular activities in which you have participated, if any, and specify the nature of your involvement in each.

Activity Role Hours Contributed Year(s)

1.

2.

3.

Work Experience/Volunteer Experience

List part-time jobs or volunteer opportunities you have held, if any, specifying employer, type of work and length of time in position.

Employer Type of Work Hours Contributed Year(s)

1.

2.

3.

If there are facts about you that have not been identified in the outlined requirements that you feel we should be aware of, please include this information.

5.

Terms and Conditions

1. MindFuel reserves the right, in its sole discretion, to modify, amend or cancel the MindFuel Scholarships Program (the “Program”) at any time without notice, and to decide all questions respecting the awarding of Scholarships, and the administration of the terms and conditions of the Program.

2. The following persons are NOT eligible to receive a Scholarship: employees of MindFuel; the children of MindFuel employees; and Program applicants (“Applicants”) who provide false information to MindFuel at any time.

3. To be eligible for a Scholarship, Applicants must: a) Be an Alberta high school graduate or graduating in 2015 from an Alberta high school. b) Be Canadian citizens or have permanent resident status c) Certify that all the information provided on the Program application form (“Application”) and in all the accompanying documents is true, accurate and complete to the best of their knowledge.

4. By submitting an Application, the Applicant authorizes MindFuel, the Scholarship judges, The Association of Universities, Polytechnic and Colleges of Alberta, and their respective representatives to collect, use, store and confirm information about the Applicant, provided on the Application submitted (including references) to those who need to know such information for the purposes of administering and promoting the Program. The selection committee will use the information only for the purposes of evaluating the Application.

5. A Scholarship awarded under the Program can be only be used at any college, polytechnic or university in Alberta. The Scholarship recipient (“Recipient”) is responsible for securing admission to an approved school of their choice, in accordance with the requirements and deadlines of each school.

6. The MindFuel Scholarships Program: a) Award funds will be sent to the Registrar after official transcript cconfirmation of full-time enrollment in post-secondary studies is provided by the student from their approved school to MindFuel

b) Reserve the right to publish and/or disseminate information regarding its scholarship winners including students’ name and photos.

7. The Recipients must: a) Attend an approved school on a full-time basis (as defined by the school) b) Be enrolled in a course of study leading to an undergraduate sc ience, appl ied

sc ience or sc ience educat ion degree/diploma. 8. A Scholarship may be terminated at any time by MindFuel, upon the occurrence

of any behavior on the part of the Recipient, that MindFuel, in its sole discretion, deems inappropriate.,

9. All Recipients must inform themselves as to the tax consequences of receiving the Scholarship.

10. All Recipients will be required to sign a Declaration and Release which will entitle MindFuel to use the Recipient’s name, city and province of residence, and photograph, without further compensation for any publicity carried out by MindFuel with respect to the Program.

11. MindFuel will establish an alumni network for recipients of the MindFuel Scholarships (the “MindFuel Scholars Alumni Network”). You will automatically join the MindFuel Scholars Alumni Network. Membership in the MindFuel Scholars Alumni Network includes but is not limited to: invitations to MindFuel events; participation on MindFuel Scholarship advisory councils; and invitations to join MindFuel Scholarship social groups. You may terminate your participation in the MindFuel Scholars Alumni Network at any time by notifying: Scho larsh ip@MindFue l .ca MindFuel Suite 260, 3512 – 33 Street NW. Calgary, Alberta T2T 1T7.

12. Membership in the MindFuel Scholars Alumni Network may be terminated at any time by MindFuel, upon the occurrence of any behavior on the part of an alumnus that MindFuel, in its sole discretion, deems inappropriate.

Acknowledgement and Authorization

I understand that the information submitted in and with this application will be used to assess my eligibility for the scholarship. I certify that all the information provided on this

application form and in all the documents accompanying it is true, accurate, and complete. I have read all the Terms and Conditions as listed above. By submitting this application, I

agree to be bound by all these Terms and Conditions.

Signature Date If under 18 years of age, a signature of parent or legal guardian is required.

Signature Date

Name (printed)

Please take a moment to answer the following question to help us improve the program. How did you hear about the MindFuel Scholarships for Post-Secondary STEM and Science Education Based Learning Programs?

a. Family/Friend b. Facebook c. Internet d. School/Teacher e. Email f. Twitter

6.