THE RICHARD AND MARY PELLING BURSARY FUND
2014 / 2015
The Richard and Mary Pelling Bursary has been made available through the generosity of Mr. Peter Gordon Pelling
in memory of his parents, Richard and Mary Pelling.
The Pelling Bursary will be awarded on the recommendation of the Pelling Educational Review Committee and is
based upon demonstrated financial need.
CRITERIA
1.
The award is for students in a health discipline at McMaster University, Faculty of Health Sciences or
Faculty of Social Sciences.
2.
The award will be open to full-time students enrolled in a health discipline and studying psychiatry, Faculty
of Health Sciences / Faculty of Social Sciences, McMaster University. Applicants must have psychiatric
clinical / research experience in the Integrated Mental Health Program (Hamilton Health Sciences, St.
Joseph’s Healthcare) during the academic year (September 2014 – August 2015).
3.
Applicants must demonstrate, in writing, how the bursary will financially benefit them in pursuing their
studies in the field of psychiatry (mental health) at McMaster University.
4.
The successful candidate(s) must agree to use the award in the academic year for which it has been
presented. Students or residents will be eligible to apply for bursary monies each year of their program.
5.
Should the recipient(s) be unsuccessful in or withdraw from the program, reimbursement of bursary monies
will be negotiated at the time of notification. Funds will be sent when proof of full-time registration has been
received from the appropriate department or School, Faculty of Health Sciences / Faculty of Social
Sciences, by the Hamilton Health Sciences Foundation.
6.
Preference will be given to applicants who have not previously been awarded a bursary from this fund,
provided applicants are of equal merit.
7.
The recipient of a bursary will be required to submit notification of successful completion of the funded year
to the Foundation Office, 40 Wellington Street North, P.O. Box 739, LCD 1, Hamilton, Ontario, L8N 3M8 no
later than October 1, 2015.
8.
In addition to, but not to the exclusion of, financial need, the committee may consider the following in
awarding funds where there are more qualified candidates than awards available:
a) the appropriateness of the program to the goals and objectives of the individual applicant
b) recent participation in hospital, professional association, publications, university, volunteer and
community activities
c) employment experience
d) overall ability to express oneself in the cover letter
APPLICATION PROCESS
1. Five copies of a complete application package must be received in the Foundation Office at: Hamilton
Health Sciences Foundation, 40 Wellington Street North, P.O. Box 739 LCD 1, Hamilton, Ontario, L8N 3M8,
clearly marked “Application for The Richard and Mary Pelling Bursary” no later than November 12th, 2014.
There will be no extensions.
2.
A complete application package includes:
a)
a completed application form;
b)
a cover letter indicating how the program will benefit the individual financially and reflective of the
applicant’s professional, academic and clinical practice goals;
c)
a budget outlining how the bursary money would be spent;
d)
a current resume to include work history, educational history and membership and participation in
hospital, professional, university, volunteer and community organizations and activities;
e)
transcripts of previous university courses or programs (photocopies are acceptable);
f)
proof of full-time registration (or application for registration) from the program administrator or
director of the student’s or resident’s department or School, Faculty of Health Sciences / Faculty of
Social Sciences, McMaster University (photocopy is acceptable); and
g)
Letters of support from two academic professors or advisors, and confirmation of the expected level
of clinical experience for the student at Hamilton Health Sciences during the academic year from
the following:
i)
ii)
for medical/nursing students, a letter of reference from the Assistant Dean
Undergraduate Medical Program; or
for others, a letter of reference from the Chief of Academic Department of the
applicant’s academic program, Hamilton Health Sciences.
APPLICATION FOR
THE RICHARD AND MARY PELLING
BURSARY FUND
Please forward, no later than November 12th, 2014 to:
Hamilton Health Sciences Foundation, 40 Wellington Street North, PO Box 739, LCD 1, Hamilton, L8N 3M8
Five (5) copies of the following:
a) completed application form;
b) a cover letter expressing how the scholarship will benefit you in the pursuit of your studies in psychiatric
(mental health) medicine;
c) budget outlining how the scholarship money would be spent;
d) a current resume;
e) transcripts from previous university courses and programs;
f) letters of support from two academic professors or advisors;
g) proof of full-time registration (or application for registration) from the program administrator or director of your
department or school, Faculty of Health Sciences / Faculty of Social Sciences, McMaster University; and,
h) a letter of reference from the Assistant Dean Undergraduate Medical Program for medical/nursing students, a
letter of reference from Chief of the Department of Psychiatry or Chief of Academic Department of the
applicant’s academic program for residents.
Note: Your letter is a critical element in determining the success of your application. Your ability to demonstrate reflective
thought and sequencing of ideas and present this in writing is a consideration in the rating of applications.
Staff Member of HHSC:
Yes
No
APPLICATION
DATE:
HOME
PHONE #
NAME:
CELL
PHONE #
FULL ADDRESS:
E-mail:
Award:
BURSARY
(Awarded based on demonstrated financial need)
STUDENT OF WHICH SCHOOL
OR DISCIPLINE?
1st
YEAR:
2nd
3rd
4th
Resident (scholarship only)
Other:
THE RICHARD AND MARY PELLING BURSARY FUND
By receiving this award, I agree that should I fail to successfully complete the academic year to which the bursary/
scholarship applies, or withdraw from the program during said academic year, I will repay the amount of funds
disbursed by the Hamilton Health Sciences Foundation.
SIGNATURE OF RECIPIENT
DATE
The Successful Candidate(s) will be required to furnish the Foundation with a valid Social Insurance Number before transfer of any funds.
RICHARD AND MARY PELLING BURSARY FUND
2014-15 Budget Form
Name: ____________________________________
Financial Information
Enter your estimated expenses and resources below. All lines must contain one of the following: a dollar amount,
“0’ or “N/A’. If any line is left blank, the application will be considered incomplete. Note: Hamilton Health Sciences
Foundation reserves the right to request any invoices or copies of official or legal documentation in connection with
this application.
My study period begins: ___/___/___/ (dd/mm/yyyy) and ends: ___/___/___ (dd/mm/yyyy)
This budget covers my:
 4 month
Estimated Expenses
Tuition & Supplementary
fees
$________
Books & Supplies
Residence / Rent
$________
$________
Groceries / Dining Out/ Meal
Plan
$________
Phone / Cable / Internet
$________
Cellular Phone
Utilities
Clothing
Entertainment & Personal
$________
$________
$________
$________
Uninsured
medical/dental/optical
Child Care (unsubsidized
amount)
Transportation
$________
Minimum Credit Card
Payments
$________
Other:
______________________
TOTAL EXPENSES
$________
$________
$________
$________
 8 month  12 month study period
Estimated Resources
Assets (bonds, term deposits,
bank accounts, etc.) as of 16
weeks prior to study period
start
$________
Vehicle Value
Student Contribution from
income earned 16 weeks prior
to study period start
Student Contribution from
income that will be earned
during study period
Parental/Spousal Contribution
$________
$________
Scholarships
Bursaries
Government Income
OSAP/Out of Province Loan
Which Province: _______
Bank Loan/Line of Credit
$________
$________
$________
$________
Part time Canada Student
Loan/Canada Study Grant
Part-time Ontario Special
Bursary
McMaster Tuition Assistance
(for employees/dependents)
$________
Other
______________________
TOTAL RESOURCES
$________
$________
$________
$________
$________
$________
$________
Financial Profile
Total outstanding OSAP (or-out-of-province student loans) borrowed to date
$____________________
Total outstanding bank loans/lines of credit borrowed to date
$____________________
Number of vehicles which you/your spouse (if applicable) own or lease?
$____________________
Total estimated value of your/your spouse’s (if applicable) vehicles
$____________________
Pre-Study Period Contribution
Please indicate if you worked during your pre-study period (eg. 16 weeks prior to the start of your study period)
 Yes
 No
If “Yes”, Number of weeks worked: _______
Average hours per week: ________
Total gross income
$____________________
If “No”, state reason:
Study Period Contribution
Will you be working during study period?
 Yes  No
If “Yes”, Estimated earnings
$____________________
If “No”, state reason:
If you have been out of high school less than 4 Years:
Please list each dependent in your family (i.e. brothers and sisters); including yourself (a dependent is out of high school
less than 4 years).
List their names, date of birth, school attending, and last date that they each attended high school. You
may attach a separate page if needed.
Your parent/step-parent/guardian income information:
Father’s total gross income
$____________________
Mother’s total gross income
$____________________
Please include your parent(s)’ Income Tax Notice of Assessment for 2012
If you are a married student or sole-support parent:
How many children are living with you during the study period?
_______
If you are a married student:
What is your spouse’s total gross income?
$____________________
Please include your spouse’s Income Tax Notice of Assessment for 2012