Scholarship Application
Introduction
In keeping with Em’s spirit of giving, the Emmy Duff Scholarship Foundation is dedicated to providing
scholarships to deserving students. The Scholarships will support post-secondary academic endeavours
and recognize the personal triumphs of exemplary students.
The $2,000 Emmy Duff Scholarship is a one-time award for full-time students in a college or university
program in Canada. Students may be in any year of their studies provided that they are enrolled for
school for the 2016 fall term.
Eligibility
The Emmy Duff Scholarships ($2,000 each) are open to students who:
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Are currently attending or will be attending a Canadian university or college program for the
2016/2017 academic year. Confirmation of enrolment as a full-time student is required.
Are in any year of their studies (must be enrolled for the 2016 fall term);
Are resident of and currently residing in Canada;
Have demonstrated an ongoing volunteer commitment to causes that are important to them
Have undergone treatment or are currently being treated for cancer.
Required Documents
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Completed application form. Only 2016 application forms will be accepted.
Statement from your oncologist or current physician confirming that you were treated (or are
currently receiving treatment) for cancer(not required if you have applied in a previous year).
300-500 word letter describing your personal life experience, your future goals, and why you are
applying for this scholarship. Please include any details that you feel are relevant.
Letter of acceptance from the Canadian post-secondary institution you will be attending in
September 2016.
Deadline for Submission
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Friday, June 10, 2016 (Applications received after this date will not be accepted).
Questions?
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For more information about the Scholarships, please email scholarships@emmyduffscholarship.org
Scholarship Application
Application Process
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Email the required documents as a pdf (preferable one pdf) to scholarships@emmyduffscholarship.org
Mark the subject line of the email as ‘2016 Scholarships – Your Name’
All applications are due not later than Friday, June 10, 2016 at 5 PM EST
All applicants will be notified by email in August 2016 about the status of their application
Scholarship cheques will be issued to the college or university once confirmation of full-time
enrolment in your post-secondary program and proof of fees paid has been received by us
Adjudication
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Applications will be reviewed by the Board of the Emmy Duff Scholarship Foundation.
Scholarship Application
Student’s Personal Information
First Name:
Last Name:
Initials:
Gender:
Female
Male
Email Address:
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Telephone:
Home:
Cell:
Home (Permanent) Address:
City:
Unit/Apt.:
Province:
Postal Code:
Date of Birth (Month/Day/Year):
Student’s School Information
Name of College or University:
Degree Program:
Year of Study (as of Sept. 2016):
Proof of Enrollment:
Please attach verification of the college or university you will be attending in September 2016 (such as a copy of the
letter of acceptance). Proof of enrollment will be required once the Fall term has begun.
Cancer Treatment Story
Type of cancer (please be specific):
Age at diagnosis:
Hospital of treatment:
Name of Oncologist:
Name of Nurse:
Name of Social Worker:
Are you currently
receiving treatment?
Applicants must also attach a letter, to support their application, from their oncologist, current doctor or a member of
their oncology health care team (i.e. social worker, nurse, etc) confirming that applicant was treated, or is currently
being treated, for cancer.
Scholarship Application
Information on Volunteer work, including why you chose this cause (if you have more than one
position/organization of volunteer experience please append an additional page to your application form):
Name of Organization:
Time Period of Volunteer work:
Description of Volunteer work:
Future Goals for Volunteering:
Reference:
Name, Phone number, email:
Personal Statement:
This is to be in the form of a letter to the Foundation. The letter should describe you (including your interests and
activities), your academic achievements and your future goals and why you feel you are a candidate for an Emmy Duff
Scholarship. The letter should also include a statement about how this scholarship would make a difference to you.
Please append your letter to your application.
Scholarship Application
I hereby declare that all information given on this application is true and complete in every respect. I
understand that I may be required to repay all or part of the award if the information is found to be inaccurate
for any reason.
I hereby acknowledge that in furtherance of the application herein contained, I have been requested to provide
certain personal information to the Emmy Duff Scholarship Foundation and that I may subsequently be
requested to provide additional information. I further acknowledge that the Emmy Duff Scholarship Foundation
may make enquiries in respect of the information contained in this application from the parties listed herein. I
consent to the collection, use and disclosure of such personal information as may be required by the Emmy
Duff Scholarship Foundation from time to time in the course of its business, including, without limitation, for
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purposes related to the decision to grant or deny a scholarship.
I hereby acknowledge that for purposes of the Foundation’s website, its annual newsletter and other material
provided to the Foundation’s donors and potential donors, I consent to the use of certain personal information
contained in this application. I also agree to provide the Foundation with a digital photo (jpeg) of myself that
may be included on the Foundation’s website and/or in the Foundation’s annual newsletter.
Student Name (printed)
Signature
Date
We would like to know how did you hear about the Emmy Duff Scholarship Foundation?
If more than one applies, please check as well.
□ Childhood Cancer Canada
□ Teen Connector Website
□ Hospital
□ Support Group
□ Social Worker/Nurse
□ Social Media (Facebook/Twitter)
□ Young Adult Cancer Canada (YACC)
□ Other (please specify):
□ Leukemia & Lymphoma Society
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This acknowledgement is requested pursuant to applicable Canadian privacy legislation.
Scholarship Application
Application Checklist (Do not send in this page, keep for your records):
Completed application
Letter from oncologist or current doctor or other member of oncology health care team
confirming you were treated or are currently being treated for cancer
Personal statement letter to the Foundation
Proof of enrolment from the post-secondary institution you will be attending in September
2016, such as a Letter of Acceptance
Documents to be sent as PDF files to scholarships@emmyduffscholarship.org by Friday, June 10,
2016
Note: Confirmation of enrollment at your post-secondary institution and proof of fees paid will be
required once school starts in the fall of 2016.
For any inquiries, please contact scholarships@emmyduffscholarship.org
Thank you for applying for a 2016 Emmy Duff Scholarship