Fillable Dr. Gary McPherson Leadership Scholarship Value $2,000 (University of Alberta)

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Dr. Gary McPherson Leadership Scholarship Value $2,000 (University of Alberta)

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Dr. Gary McPherson Leadership Scholarship Last revised August 2019
Dr. Gary McPherson
Leadership Scholarship
Value – $2,000
The Dr. Gary McPherson Leadership Scholarship recognizes students who have demonstrated outstanding leadership, especially in the area of disability,
and/or initiative to improve the conditions and lives of others.
Eligibility Criteria
Applicants 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 has maintained permanent residence in Alberta for 12 consecutive months prior to the person
attending post-secondary
• be enrolled full-time in a post-secondary program: undergraduate, professional, graduate, apprenticeship, diploma or certicate
program at a publicly-funded institution in Alberta in the current academic year, and
• have shown outstanding leadership, especially in the area of disability, and/or initiative to improve the lives of other people while
attending a publicly-funded post-secondary institution in Alberta, and
• be in satisfactory academic standing as determined by the post-secondary institution.
Selection Process
Selection will be made on the basis of the role and contribution each student has made to their school as well as the documentation
provided with the application. There are a limited number of scholarships available to each school and application deadlines vary
by school.
Application Process
Applicants must include with their application the following:
• a resumé highlighting your leadership involvement and extra-curricular activities related to improving the lives of other people,
• a related letter of reference, and
• an essay of up to a maximum of 1,000 words - please refer to page 2 of the application for details.
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 Apply
Application Deadline:
Submit application to: Post-Secondary Institution Student
Award Ofce
Payment:
Contact:
19/20
FGSR
University of Alberta
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*
*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, has your spouse/partner maintained
permanent residence in Alberta for 12
consecutive months prior to you attending
post-secondary.
Yes
No
Dr. Gary McPherson
Leadership Scholarship
To be Submitted by the Post-Secondary Institution
Dr. Gary McPherson Leadership Scholarship Last revised August 2019 Page 1
FOIP Collection Notice or Personal Information Protection Act (PIPA) Notice
Choose X if you do not identify as male
or female, or choose to self-identify as X.
19/20
FGSR
University of Alberta
(Schools must provide FOIP or PIPA collection notices, as required)
Dr. Gary McPherson
Leadership Scholarship
Dr. Gary McPherson Leadership Scholarship Last revised August 2019 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
Level of Study: (check one)
Master Level
Ph.D Level
Undergraduate
Professional Program (e.g. medicine, veterinary medicine, optometry, etc.)
Expected Credential (e.g. upgrading, transfer, degree, diploma, certicate, other)
Alberta Student Number (mandatory)
Additional Information
Dr. Gary McPherson Biography
Dr. Gary McPherson was an extraordinary Albertan who sought to improve the conditions and lives of people through his outstanding
leadership ability. Despite being paralyzed due to polio, McPherson was a sports enthusiast throughout his life and helped to transform
wheelchair sports into a worldwide sporting movement known as the Paralympics.
McPherson was also a leader and advocate for the disabled community serving as Chair of the Premier’s Council on the Status of
Persons with Disabilities and Vice-Chair of the Alberta Paraplegic Foundation. Gary received signicant recognition and awards for
his achievements including the prestigious Order of Canada, the Queen’s Jubilee Medal, the Alberta Order of Excellence, and both
the Edmonton and Alberta Sports Halls of Fame.
Above all, Gary dedicated his life to his family and to activities that promoted community development and support for young people.
Gary passed away on Saturday, May 8, 2010.
Student ID
Prov/State
Postal/Zip Code
Anticipated Date of Completion
Month Year
Years
Months
Year of Program
Dr. Gary McPherson Leadership Scholarship - Biography
After reading the biography of Dr. Gary McPherson please attach an essay of up to a maximum of 1,000 words using examples
of how you have shown leadership, especially in the area of disability, and/or initiative to improve the lives of others.
The essay should be typed, double-spaced and use a font size no smaller than a size 10.
19/20
Dr. Gary McPherson
Leadership Scholarship
Dr. Gary McPherson Leadership Scholarship Last revised August 2019 Page 3
Declaration of Applicant
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
I have read and understand the instructions, and declare that:
• all information provided is true and complete and I understand it is subject to verication.
• I will immediately notify ______________________________________________ if there are any changes to the information I have
provided in this application.
• I authorize my post-secondary institution to disclose information collected on this application form, my program of study and
any award details (if I am selected) to Alberta Student Aid, and I authorize Alberta Student Aid to collect this information from the
post-secondary institution for the purposes of administering the Dr. Gary McPherson Leadership Scholarship under the Heritage
Scholarship Act, including conrming my eligibility and suitability for this award, for program evaluation and for research and
statistical analysis.
19/20
(school name)
(School may insert any additional required text below regarding any further declarations deemed required by the school)
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Completed 30 September 2020

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