THE CANADIAN ROBERT T. JONES JR.
SCHOLARSHIP APPLICATION FORM
(Please complete in typescript, if possible, or print using black ink.)
�Mr.
� Mrs.
�Miss
� Ms.
Surname: ___________________
Given Name(s): ______________________
Student I.D.: ____________________
Date of Birth: ________________________
Current Address: ________________________________________________________________
Current Phone:_________________________
Permanent Email Address: __________________________________
Permanent Address:______________________________________________________________
Permanent Phone Number: __________________________
Faculty: __________________
Department: ___________________ Year of Study: _______
The Canadian Robert T. Jones Scholarships are designed to reward all-around excellence in students
exchanging between the University of St. Andrews, Scotland and selected Canadian universities. These
scholarships are awarded on the basis of outstanding academic performance to candidates who
demonstrate a passion for the pursuit of learning and a commitment to the ongoing life of their university
and/or wider community.
Conditions
Value:
Four at a minimum of $6,000 (Cdn); paid in two installments, 2/3 in
Fall term, 1/3 in Winter term.
Eligibility:
Undergraduates from main campus or an affiliated university college
who are eligible to enter the third year of a participating Honours
program in the Faculties of Arts & Humanities, Social Science, or
Science at the University of St. Andrews, who have obtained a
minimum academic average of 80%.
Method of Selection:
A selection committee at both universities composed of university
academic staff will adjudicate the applications and will, in
cooperation with the Board of Trustees of the Canadian Robert T.
Jones, Jr. Scholarship Foundation, select the award winners. Golf
skill is not a criterion.
Decisions will be made by mid-February each year.
Submit to:
International and Exchange Student Centre
Room 2120, Western Student Services Bldg.
Western University
APPLICATION DEADLINE: December 2nd 2013
Academic Performance
Number of courses taken and/or enrolled in to date: _______________________________
Program of study: __________________________ Present Year: ___________________
Faculty: ________________________________
Degree to be obtained: ____________
What are your long-term career plans?
How might the scholarship help you realise them?
List any academic awards/scholarships/bursaries and/or prizes you have held, now hold, or are applying
for. Please give details, including what criteria you met to win the award, amount, and duration.
Note: Please include your official transcript.
Work Experience
Name of Employer
From
To
Type of Work
Time Spent Abroad
What countries have you visited or resided in? State when and for how long. Omit any periods of less
than two weeks.
Leadership and Extracurricular Achievements
List your extracurricular university activities and outside interests.
Please give details of any positions of responsibility and/or leadership that you have held in the
University and/or community. Please comment on how these experiences/activities benefited you and
also contributed to your intellectual growth.
The Scholarship
If your application is successful, what course(s) of study would you hope to take at the University of St.
Andrews?
How would you expect to benefit from the opportunities the scholarship provides?
How do you think you might contribute to your host university during your time there?
Please provide an essay of no more than two typed, double-spaced pages outlining your personal
impressions of Robert T. Jones, Jr. and the impact that he had. Please do not simply recount the
biographical details of his life.
Names of two professors, including discipline affiliation and university department (or other address),
asked to forward a reference to the local selection committee in support of your application:
1
______________________________________________________________________________
______________________________________________________________________________
2
______________________________________________________________________________
______________________________________________________________________________
Health
If you know of any special condition, which might affect your eligibility for Health Insurance, you must
advise the Canadian Robert T. Jones, Jr. Scholarship Program Coordinator. This may be done by a
personal letter.
Checklist
Please ensure that you enclose the following supporting documentation:
� Official University Transcript
� Essay
Please provide an essay of no more than two typed, double-spaced pages outlining your personal
impressions of Robert T. Jones, Jr. and the impact that he had. Please do not simply recount the
biographical details of his life.
� UWO Exchange Application (online at our website)
� 2 letters of reference
� $25 Application Fee
To the best of my knowledge, the information provided in this application is correct and true and of my
own effort.
I authorize my university to release my academic record to the committee for the Canadian Robert T.
Jones, Jr. Scholarship.
Signature: ___________________________________ Date: _______________________
UWO / ST. ANDREWS UNDERGRADUATE EXCHANGE
Required Supplementary Information
Academic Performance
Courses taken and/or enrolled in to date:
Year I:
1
2
3
4
5
6
_______________________________________ Grade: ______________
_______________________________________ Grade: ______________
_______________________________________ Grade: ______________
_______________________________________ Grade: ______________
_______________________________________ Grade: ______________
_______________________________________ Grade: ______________
Year I Average: ______
Year II Courses: (Professors; grades to date; % of final grade)
1
2
3
4
5
6
7
8
9
10
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
The personal information collected pursuant to this scholarship application is collected under the authority of the University of Western Ontario Act, 1982, as
amended, and is used to administer the scholarship program and determine scholarship winners. Information shall be disclosed to committee members at
Western and St. Andrews University. Please direct questions about this collection, use, or disclosure of personal information to the International Exchange
Coordinator, Student Development Centre, The University of Western Ontario, London, ON, N6A 3K7, tel: 661-2111, ext. 85196.