Portuguese Association
at
York University
Merit Award Application
for
Students Entering York University in Fall 2013
Portuguese Association at York University (YUPA)
4700 Keele Street 002B Winters College, Toronto, Ontario, M3J 1P3
Tel: 416-736-2100 ext. 77530
E-mail: yupa.club@gmail.com
Portuguese Association at York University
Merit Award 2013
Information Form
Instructions for all YUPA merit awards are outlined in this application form.
Please read carefully.
For inquiries contact YUPA at yupa.club@gmail.com or 416-736-2100 ext. 77530.
These awards are for students entering York University in fall of 2013.
***PLEASE RETURN ALL APPLICATIONS TO THE ATTENTION OF MELISSA
PEREIRA FROM THE PORTUGUESE ASSOCIATION AT YORK UNIVERSITY AND
INDICATE “RE: SCHOLARSHIP APPLICATION ENCLOSED” TO 4700 KELE
STREET, 002B WINTERS COLLEGE, TORONTO, ONTARIO, M3J 1P3***
INSTRUCTIONS:
1. Write or type all information within the space provided or on an attached sheet.
2. Proofread all information and make sure that everything is filled out to the best of
your ability.
3. Sign and date Section F and have your endorser sign and date the section as well.
4. Attach a sealed original transcript to date as well as a copy; also, please make a
copy of
the entire application and include it in the application package to be
submitted.
ELIGIBILITY:
High school, college, and mature students (those out of school for 2 years or more)
entering into their first year at York University are eligible if they are/have:
1. A Canadian citizen or landed immigrant of Portuguese descent/descendent of a
Lusophon nation and/or
2. An international student of Lusophone origin
3. Attending York University in fall 2013, provided they are accepted to the University
4. A minimum average in their graduating year of 75%
5. Participated in at least 3 extracurricular activities while in high school (each year
counts as a separate volunteer example, list it accordingly).
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Portuguese Association at York University
Merit Award 2013
CALENDAR AND DEADLINES:
• Deadline for this application is May 1st, 2013.
• Successful candidates will be notified of their final standing and offered the
scholarship by June 1, 2013.
• Recipients will be asked to attend our annual scholarship event (June 2013) in their
honour to accept their award
IF AWARD IS GRANTED AND ACCEPTED RECIPIENTS WILL RECIEVE:
1. A one-time award between $500 and $1500 (given that documentation is provided
proving their acceptance to York University).
2. Free Membership to the Portuguese Association at York University (YUPA) for their
first year of university.
3. An invitation to the Portuguese Association at York University’s Scholarship
Ceremony held at York University in June 2013 honouring all recipients.
4. A renewing scholarship between $200 and $500 for the 2014-2015 academic
year (recipient’s second year) provided that:
 During the 2013-2014 academic year recipient attends a minimum of three
YUPA meetings per semester or contributes a minimum of five hours per
semester towards YUPA initiatives, which include but are not restricted to:
attending meetings, tabling, assisting at a YUPA run event (ie. set up and
clean up), recruiting new members, promoting events, etc.
 Recipient attends YUPA’s Annual Winter Ball in 2014, as well as at least one
of YUPA’s other three main events during the 2013-2014 academic year,
which are:
o YUPA’s Halloween Party
o Multicultural Week at York University
o YUPA’s Fashion Show
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Portuguese Association at York University
Merit Award 2013
Personal Information Form
IMPORTANT: Please do not forget to include TWO FULLY COMPLETED COPIES of this form
in the application package that you will be submitting to the association. Please type or print
clearly (blue or black ink only). The information contained in the personal information form will
be used for all association correspondence. Please ensure that the information you provide is
complete, accurate, and up to date.
Last Name: _____________________________
Middle Name: _____________________
Gender: □ Female □ Male □Other
First Name: _____________________________
Home Address: ______________________________________ Apt: _____________
City: _________________ Province: ________________ Postal Code: _______________
Home Telephone Number: ___________________ Mobile: ______________________
Date of Birth (YYYY/DD/MM):_________________ Place of Birth: _____________________
E-mail Address: _____________________________________________________________
Status for 2012-2013 academic years (please select one of the following):
□ Out of school □ Public/Catholic high school □ Private school □ College/Professional school
Name of School (if presently in school):___________________________________________
School address: ___________________________________ Telephone:________________
City: _______________________ Province: __________________ Postal Code: __________
How did you learn about this scholarship?
□ Guidance counsellor(s) □ teacher(s) □ friend(s) □ website □ community group
□ Advertisements (posters) □ other: _____________________
The program you applied for at York University belongs to the faculty of:
□ Health Science □ Science & Engineering □ Fine Arts
□ Schulich School of Business
□ Liberal Arts & Professional Studies □ Other (please specify):____________________
Citizenship and Background (please select one of the following):
□ Canadian Citizen of Portuguese descent (includes Lusophone descent (Portuguese-speaking))
□ Canadian and Portuguese citizen □ Portuguese citizen only □ Other (please specify):_____________
What language(s) do you speak?
□ English □ Portuguese □ Other (specify):_____________
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Portuguese Association at York University
Merit Award 2013
SECTION A:
Name of mother/guardian: ______________________ □ Deceased
Home Address (if different from applicant):___________________________ apt: _______
City: _____________ Province: _______________ Postal Code: ____________
Home Telephone Number: ___________________ Occupation: ___________________
Name of father/guardian: _______________________
□ Deceased
Home Address (if different from applicant):___________________________ apt: _______
City: _____________ Province: _______________ Postal Code: ____________
Home Telephone Number: ___________________ Occupation: ___________________
How many siblings do you have? ______
Are any of your siblings currently attending/have completed post-secondary education? YES NO
SECTION B: (for applicants entering a post-secondary institution as a mature student)
Marital Status: _____________________________ # of Children: _________ Age(s): ________
Current Occupation: __________________________________________________________
If married, what is your spouse’s current occupation: __________________________________
SECTION C- ACADEMICS:
Please select the square that represents your official grade average from the previous year (i.e. based
on grade 11 average if presently graduating in grade 12). Be sure to include 1 original copy of your
transcript and one photocopy:
□ 75-79
□80-84
□ 85-89
□ 90-94
□ 95-100
Please list ANY academic scholarships, special recognition, honours or awards at the school, district,
regional or national level that you have achieved in school or in a community related activity within the
last four years:
1. ________________________________________________________________________
2. ________________________________________________________________________
3. ________________________________________________________________________
4. ________________________________________________________________________
5. ________________________________________________________________________
6. ________________________________________________________________________
7. ________________________________________________________________________
8. ________________________________________________________________________
9. ________________________________________________________________________
10. ________________________________________________________________________
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Portuguese Association at York University
Merit Award 2013
SECTION D- COMMUNITY SERVICE:
Please answer the following questions on a separate sheet. Keep your responses to a MAXIMUM of 500
words each. Be sure to double space your responses and include your name (last name, first name) on
each page.
1. Describe how you have contributed to the Lusophone community and describe what issues it faces today.
Please be sure to include one example, from your school community or community where you live, etc. Also
offer at least one suggestion on how to address this community’s needs
2. Please list three experiences you contributed to as part of an extracurricular activity. How did these
experiences influence the group? What have you learned from these experiences?
SECTION E - FINANCIAL NEED:
Please answer the following questions to the best of your ability.
1. Have you applied for or are going to apply for OSAP? □ Yes
2. Will you be living on campus if accepted to York University?
□ No
□ Yes
□No
(If you responded yes, please go to question 5)
3. What will be your method of commuting to and from York University?
______________________________________________________________________________________
_________________________________________________________________________________
4. Approximately how many kilometres do you live from York University? ______________
5. Have you received any scholarships?
□ Yes
□ No
If so, which ones?
______________________________________________________________________________________
_________________________________________________________________________________
6. Briefly describe the method of how you will finance your post-secondary education during the academic
year (i.e. scholarships, OSAP, bank loan, working, etc.) If you plan on working throughout the academic
year, how many hours per week approximately will you work?
________________________________________________________________________________
________________________________________________________________________________
7. Are there any special family/personal circumstances that impact your situation and/or do you wish to
include any other information?
If none, indicate by placing “N/A”
(For question 7, attach a sheet with your response (if any) briefly describing your circumstances / situation.
Be sure to double space your responses, and include your name (last name, first name) on any attached
page.)
____________________________________________________________________________________
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Portuguese Association at York University
Merit Award 2013
SECTION F- CERTIFICATION AND RECOMMENDATIONS:
Teacher/ Advisor/ Guidance Counsellor
I certify that the information provided in this nomination form is true and correct.
Full name: _____________________________________________
Title: ___________________
Telephone Number: _________________________ Email: ___________________________
I have known the applicant from ______ - ______ in my position as a _________________.
_________________________
__________________________
________________
Print Name
Signature
Date
Student
I certify that the information provided in this nomination form is true and correct.
_________________________
__________________________
________________
Print Name
Signature
Date
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Alliance of Portuguese Clubs and Associations (ACAPO)
Scholarship Award Night
All of the associations, clubs and student groups affiliated with ACAPO have been
asked to offer students of Portuguese descent a one-time academic scholarship. The
Portuguese Association at York University (YUPA) is proud to say that we have been
awarding scholarships to deserving students for over 10 years and will be awarding one
of our scholarships at ACAPO’s Scholarship Award Night.
If you would like the opportunity to be eligible for the scholarship that the Portuguese
Association at York University will be presenting at the ACAPO Scholarship Award
Night on the date of May 11th 2013, please submit this scholarship application to YUPA
by MAY 1ST, 2013.
Important Information Regarding the ACAPO Scholarship:
 All requirements listed on the first and second page of this application form must
still be met and completed.
 The winner will receive a post-dated cheque on the award night, as well as a
plaque from the ACAPO. Once the Portuguese Association at York University
receives confirmation that the winner will be attending York University come fall
2013, then the cheque may be deposited.
 The winner will also be asked to attend the Portuguese Association at York
University’s Scholarship Ceremony in June 2013, where YUPA will be handing
out the remainder of their scholarships.
 The recipient will receive all the same benefits as the other YUPA scholarship
recipients listed on page two of this application.
 Please note that the Alliance of Portuguese Clubs and Associations (ACAPO) will
be given a copy of your application for their own records.
 Keep in mind that the ACAPO Scholarship Award Night will be a large event
opened to the entire Portuguese community. Family and friends may purchase
tickets for this event. As the recipient of the Portuguese Association at York
University’s scholarship, you will be called up to the stage to receive your award
in front of the community. There will be media present at the event.

The Winner will be given two free tickets to the dinner courtesy of the ACAPO.
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CIRV Radio Scholarship
This year, for the first time, CIRV Radio has offered YUPA $1000.00 to be given to a
student pursuing Journalism at York University.
You can be eligible for this scholarship provided that you will major in Journalism or a
related field. If so, please indicate your major: ____________________________.
Important Information Regarding the CIRV Radio Scholarship:
 All requirements listed on the first and second page of this application form must
still be met and completed.
 The recipient will be asked to attend the Portuguese Association at York
University’s Scholarship Ceremony in June 2013 and will receive their
scholarship along with YUPA’s scholarship recipients.
 The recipient will receive all the same benefits as the other YUPA scholarship
recipients listed on page two of this application.
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