University of Alberta Alumni Association
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By completing this application form, you will be considered for one $1000 undergraduate scholarship.

To be eligible you must:
1) Be a full-time continuing student at the University of Alberta;
2) Possess leadership qualities as demonstrated by your involvement, over the past four years, in campus or community service and volunteerism;
3) Show proof of satisfactory academic standing (GPA of 2.0 or higher);
4) Have not yet received other major scholarships or awards (major awards is one valued at $4500 or higher) in the current academic year; and
5) Be either an alumnus of the University of Alberta or a daughter, son, granddaughter, or grandson of a University of Alberta alumnus.
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All information reported in this application will be considered confidential.

All awards are offered contingent upon students proceeding with their programs at this University, and only to full-time students.
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Please provide the following information and return application to the Office of Alumni Affairs by October 30, 2006
***Please TYPE ***
Personal Information:
___________________________________________________________________________________
Surname Given Name Middle Initial(s)
___________________________________________________________________________________
Current Address City Province Postal Code
___________________________________________________________________________________
Telephone Email
___________________________________________________________________________________
Student ID#
Employment (past 4 years only):
1. _________________________________________________________________________________
Employer/Position Location Date From Date To
2. _________________________________________________________________________________
Employer/Position Location Date From Date To
3. _________________________________________________________________________________
Employer/Position Location Date From Date To

Eligibility:
Eligibility for the Meloche Monnex Leadership Scholarship is limited to alumni of the University of
Alberta or a daughter, son, granddaughter, or grandson of University of Alberta alumni. Please check the category that applies:

I am an alumnus of the University of Alberta. My degree(s) / year is: _________________________

I am the (daughter, son, granddaughter, grandson) of the following University of Alberta alumnus
(please give full name, degree, and year of graduation): ______________________________________
___________________________________________________________________________________
Please list the scholarships or awards that you have been granted in this academic year (July 1-present):
___________________________________________________________________________________
___________________________________________________________________________________
Education:
Highest year of program completed as of May 2006:

High School

1

2

3

4
Faculty: ____________________________________________________________________________
Major: _____________________________________________________________________________
Faculty registered in as of September 2006: ________________________________________________
Major: _____________________________________________________________________________
Please include the following with your Application:

Service & Volunteerism form (see attached)

Academic Record (please submit an official copy of your transcript for the previous academic term)
 Reference Letters (please attach one reference from someone who is familiar with your academic work and one reference from someone who is familiar with your campus and/or community involvement and accomplishments)
Signature: (this application must be signed)
___________________________________________________________________________________
Signature Date
I certify that the information contained in this application is complete and correct. I authorize the Alumni Association Awards
Committee to access my academic transcripts and contact my referees if necessary. I further authorize the Alumni Association
Awards Committee to use my name in various public relations publications, presentations, and announcements to promote the
Alumni Association’s awards program.
Please submit this completed form with all attachments to:
University of Alberta Alumni Association Alumni Advantage Scholarship
6 th
Floor, General Services Building
Edmonton AB T6G 2H1
Phone: (780) 492-3224
Fax: (780) 492-1568
Applications received after October 30, 2006 will not be considered.
The personal information requested on this form is collected under the authority of Section 33(c) of the Alberta Freedom of Information and Protection of
Privacy Act for the purpose of administering student awards and alumni development programs at the University of Alberta. Questions concerning the collection or disposal of this information should be directed to the Coordinator of Alumni Services at (780) 492-6566.

University of Alberta Alumni Association
Consider such things as level of leadership position held, length of service/maintenance of longstanding commitment to organization.
1. Academic
Consider such things as whether or not letter written by someone who clearly knows and respects the student’s academic accomplishments.
2. Community
Consider such things as whether or not letter written by someone who clearly knows and respects the student’s campus and/or community involvement and accomplishments .

University of Alberta Alumni Association
___________________________________________________________________________________
Surname Given Name Middle Initial(s)
Please limit your experience to past 4 years only .
Complete the following in detail as this will be a determining factor in the outcome of the competition. Please attach additional pages if necessary. Do not attach a CV.
(please include a detailed description)
Start date /
End date
(past 4 years only)
Activity
Paid /
Unpaid work
Estimated number of hours spent in this activity per week and number of months/years served.
(please include a detailed description)
Start date / Activity
Paid /
Unpaid work
End date
(past 4 years only)
Estimated number of hours spent in this activity per week and number of months/years served.