Fillable 20/21 Sir James Lougheed Award of Distinction Value (Alberta Student Aid)

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20/21 Sir James Lougheed Award of Distinction Value (Alberta Student Aid)

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Sir James Lougheed Award of Distinction Last revised June 2020
Sir James Lougheed Award of Distinction
Value – Master’s Level $15,000
– Doctoral Level $20,000
The Sir James Lougheed Award of Distinction honours the Calgary lawyer, parliamentarian, senator and cabinet minister who served in several federal
parliaments in the late 1800s and early 1900s.
This award recognizes academic excellence and provides Alberta students in graduate programs with the opportunity for study outside of Alberta
at institutions anywhere in the world.
20/21
Eligibility Criteria
Applicant must:
• be a Canadian citizen, Permanent Resident or Protected Person (visa students are not eligible),
• be an Alberta resident, and to be considered an Alberta resident one of the following conditions must apply:
- one parent, or legal guardian has maintained permanent residence in Canada for at least twelve (12) consecutive months
immediately prior to commencing post-secondary studies and be residing in Alberta, or
- Alberta is the last place the student has lived for twelve (12) consecutive months immediately prior to commencing
post-secondary studies, or
- the student’s spouse/partner is an Alberta resident.
• be enrolled as a full-time student in the current academic year for both fall and winter terms in a graduate program at an institution
outside of Alberta.
An individual may receive a lifetime maximum of two awards.
Recipients may hold other awards and accept renumerative awards depending on the policy of the institution they attend.
In order to qualify for a doctoral level award, a student must have completed at least one full year of graduate study
or a master’s degree.
Selection Process
Applications are evaluated by selection members consisting of professors of Universities and Colleges in Alberta. Applications are
judged on previous academic accomplishments, program of study, appraiser evaluations, and answers to the essay question.
Application Process
Applicants must submit:
• a completed and signed application form,
• ofcial transcripts from all institutions attended,
• a resumé that includes:
- all universities, colleges or technical institutes attended
to date, including current institution,
- a list of scholarships, awards, and other forms of
achievement received,
- any publications, if any, such as the name of the journal
they were published in, and
- any performances/exhibitions (dates, location, etc.).
• references, including:
- the applicant’s name and award name, and
- the applicant’s program of study, research (if applicable),
and accomplishments.
Additional Information
There are seven (7) Master’s level and eight (8) Doctoral level awards available per year.
Alberta Student Number (ASN)
Your Alberta Student Number is on your Alberta Transcript
for High School Achievement.
If you do not know your ASN, or do not have an ASN:
• Visit learnerregistry.ae.alberta.ca for instructions.
• Call toll-free in Alberta at 310-0000 to have a Request for
ASN form mailed to you. Due to privacy issues, ASN’s will
not be given over the phone.
Deadline and How to pply
Deadline and How to Apply
• Application Deadline: January 15, 2021
• Submit application to: Alberta Student Aid
Alberta Student Aid
PO Box 28000 Station Main
Edmonton AB T5J 4R4
• Payment: March
Contact: Alberta Student Aid Service Centre at 1-855-606-2096
Visit: studentaid.alberta.ca/scholarships
Sir James Lougheed Award of Distinction
This award is for graduate study outside of Alberta only.
Advanced Education is collecting the personal information on this form under the authority of section 33(c) of the Freedom of Information and Protection
of Privacy Act (FOIP Act), as being directly related to and necessary to determine your eligibility for a scholarship under the Alberta Heritage Scholarship
Act and to administer scholarships including research, statistical analysis and program evaluation. The use and disclosure of your personal information
is managed in accordance with the FOIP Act.
If you have any questions about the collection, use or disclosure of this information, call the Alberta Student Aid Service Centre toll free at 1-855-606-2096
from anywhere in North America. You can also mail your questions to Alberta Student Aid, PO Box 28000 Station Main, Edmonton AB T5J 4R4.
20/21
Sir James Lougheed Award of Distinction Last revised June 2020 Page 1
For Office Use Only
App ID
Personal, Citizenship and Residency Information
Last Name (current legal name)
First Name (current legal name)
Apartment or Box Number
Street Address (add direction, e.g. S, NW, SE, if applicable)
City/Town
Mobile Number (format: 999-999-9999)
Telephone Number (format: 999-999-9999)
Gender:
Male
Female
X
Previous Last Name (if applicable)
Email Address (mandatory)
Indigenous Status:
Providing personal information on Indigenous students will
help measure the effectiveness of student nancial assistance
programs in relation to Indigenous students and to research
programs and services to improve student success rates. If
you wish to declare your Indigenous heritage, please check the
box that applies to you. NOTE: This is mandatory for awards
which require Indigenous status as part of the eligibility,
voluntary otherwise
.
Social Insurance Number
Birthdate
Alberta Student Number (mandatory)
Citizenship Status: (check one)
Canadian
Permanent Resident
Protected Person*
VISA (International Student)
*If you are a Protected Person, including Convention
Refugee, you must submit:
• A copy of your Social Insurance Number card AND
• A copy of one of the following:
- Notice of Decision, or
- Verication of Status Document (VOS)
The documentation must be valid on your Program of Study
Start Date.
Alberta Residency:
Did you or one of your parents or legal guardian live in Alberta
for at least 12 consecutive months immediately prior to
commencing post-secondary studies? (Do not include time
attending post-secondary studies or vacations.)
Yes
No
Middle
Initial
Prov/State Country Postal/Zip Code
Status Indian/First Nations
Non-Status Indian/First Nations
Métis
Inuit
Not applicable
Day Month Year
If no, was your spouse/partner an
Alberta resident immediately prior to you
commencing post-secondary studies?
Yes
No
Choose X if you do not identify as male
or female, or choose to self-identify as X.
Sir James Lougheed Award of Distinction
20/21
Sir James Lougheed Award of Distinction Last revised June 2020 Page 2
Current Post-Secondary Institution Enrolment Information
Post-Secondary Institution Name
Address
City/Town
Country
Program of Study
Program of Study Start Date
Month Year
Program Length
Expected Credential (e.g. upgrading, transfer, degree, diploma, certicate, other)
Additional Information
Is your Master’s/Ph.D program thesis based?
Yes
No
If yes, name of Thesis/Project Title
Contact Information
• Current Institution
• Faculty/Department Name
• Faculty Advisor Name
• Dean of Graduate Faculty Name
Historical Post-Secondary Enrolment
Highest Degree Completed
Completed at (Institution Name)
Program of Study
Student ID
Prov/State
Postal/Zip Code
Level of Study: (check one)
Master Level
Ph.D Level
Undergraduate
Professional Program (e.g. medicine,
veterinary medicine, optometry, etc.)
Anticipated Date of Completion
Month Year
Years
Months
Year of Program
Alberta Student Number (mandatory)
Sir James Lougheed Award of Distinction
20/21
Sir James Lougheed Award of Distinction Last revised June 2020 Page 3
Additional Information continued
Academic Transcripts
List the institutions providing transcripts (include your surname if it is different on the transcript).
List other scholarships for which you are applying.
Essay Question
Title of your proposed program of study:
In two pages or less, please provide a detailed description of your proposed program of study, why you are pursuing your research
(if applicable) or creative activity, and what you plan to accomplish during and after your studies.
Please attach these two pages to your application. Pages must be single-spaced, and enough space between the lines for legibility,
approximately six lines per vertical inch. Font size should not be less than 10 and condensed type is not acceptable.
References
Name the two individuals providing letters of reference.
Name
Institution
Name
Institution
If you are the successful recipient, are you able to accept this award?
Yes
No
Alberta Student Number (mandatory)
Position Held
Position Held
Sir James Lougheed Award of Distinction
20/21
Sir James Lougheed Award of Distinction Last revised June 2020 Page 4
Declaration of Applicant
I have read and understand the instructions, and declare that:
• all information provided in this application, including any
supplemental information required to establish my eligibility
(the “Application”), is true and complete and I understand
that the information is subject to review and audit.
• I have read and understood the eligibility requirements
and obligations of the scholarship and/or award as stated in
the scholarship and/or award application and requirements
documents.
• I will immediately notify Alberta Scholarships – Alberta
Student Aid, in writing if I withdraw from studies or of
any changes to my name, address, academic status or
study period, or to any other information contained in the
Application in accordance with the instructions relating to
changes of information found on the Alberta Student Aid
website, studentaid.alberta.ca.
Disclosure of Information
I understand that Advanced Education may disclose and
exchange my personal information pertaining to my high school
and post-secondary academic records, academic progress, and
enrolment status with:
• Alberta Education to verify my Alberta Student Number, name,
date of birth, and gender solely to conrm identication for
the purpose of the scholarship and/or award application.
• Any of the following: provincial and federal government
departments; the educational institution(s) named in the
Application; boards; and any third party or third party
organizations involved in the selection of the recipient.
I understand and agree:
• to provide all information requested by Alberta Student Aid
which, in Alberta Student Aid’s sole discretion, is required
to verify any statements made in this Application.
• if I receive a scholarship my name, award, and city/town
may be released publicly to promote the program. My name,
the name of the scholarship and the scholarship amount
may also be published on the Government of Alberta Grant
Disclosure Portal. However, my consent to the publication
of this personal information is not a criterion for eligibility,
and if I do not want to be identied, I will contact Alberta
Student Aid and request that it not be disclosed.
Please review your application to make sure you have completed all the required fields and that the information is accurate.
Incorrect or incomplete information will delay processing.
Your application and all supporting documentation must be received by the application deadline.
Signature of Applicant Today’s Date Alberta Student Number (mandatory)
✗ SIGN HERE
Day Month Year
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2021 Sir James Lougheed Award of Distinction Value (Alberta Student Aid)

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Completed 23 December 2020

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