2017 POLONIA CENTRE ACADEMIC AWARD APPLICATION
FOR UNDERGRAD STUDENTS ONLY

Attention Master and PhD Candidates:   An application will be posted on this site             July 03, 2017 with a filing deadline of July 25, 2017

	The Polonia Centre Academic Awards encourage and support students of our community in their pursuit of higher education.  We are looking for individuals who have made significant contributions of time and energy to the Polish community of Windsor.  They also have made a positive contribution to their school through involvement in extracurricular activities while demonstrating a competent level of academic achievement.

Criteria of Eligibility:
•	Must be a full time student and member of the Polish community in Windsor, currently attending or planning to attend a Post-Secondary institution this fall leading to a degree or diploma from an accredited community college or university.
•	Actively involved in the cultural and social life of the Polish community.
•	Canadian Citizen or Permanent Resident.		

Required Documents:
1.	Fully completed application form.

2.	Official transcript and most recent report card or final marks.  
3.	Letter of Acceptance to a Post-Secondary Program
4.	A letter of reference from an instructor written on the school’s letterhead and delivered in a                                     sealed envelope to ensure confidentiality.
5.	Two passport sized photographs with your name printed on the back.
6.	Copy of Passport Bio-data page.	

Restrictions:
A student may receive funding from this program only once in each level of study.

Deadlines:  
Applications must be submitted by 4:00 p.m. on May 19, 2017 and must be accompanied by all required documents to: Polonia Centre (Windsor) Inc , c/o the Global Maintenance Office at 5101 South National Street (across the street from the Polonia Park office). You will receive a response in June. Incomplete submissions will be returned

2017	POLONIA CENTRE AWARDS APPLICATION
Read the Instructions carefully prior to completion of this application.

	1.  PERSONAL INFORMATION:

Name:    _______________________________________________
Address: _______________________________________________
               _______________________________________________Postal Code __________      
Date of Birth:  ______________(dd/mm/yy)     Marital Status _______
Telephone _________________     E-Mail Address:________________________________________
How long have you resided in Windsor? __________

2.  EDUCATIONAL HISTORY:

Currently Attending: ___________________________________________________
Current Program of Study:   (circle one)
Secondary;   College;    Bachelor degree;    Master’s degree      

If in Post-Secondary:   Field of Study_________________________ (Circle one) Year 1,  2,  3,  4

	Intended Program of Study for Fall 2017 (circle one)
Diploma;   Bachelor;    Master;    PhD 
Where:______________________________________________
Field of Study________________________________________

Previous University or College attended: ___________________________________________
Field of Study________________________       From: _______To:_______ 	

3. CAREER ASPIRATIONS

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

4.  INVOLVEMENT WITH   “POLONIA”   IN WINDSOR
Indicate the organizations to which you and your parents belong or have belonged to in the past. 

          Organization	Member?     Or   Executive?	            Dates	Mother/Father/You?
	
Altar Server
				
Border Cities Polish Canadian Club
				
Canadian Polish Congress
				
Carousel  - Polish Village
				
Catholic Women’s League
				
Choir Member
				
Church Reader 
				
Dom Polski
				
Holy Trinity Parish Council
				
Kosciol Domowy
				
Krucjata
				
Polish Alliance Branch 20
				
Polish Canadian Business & Prof Assoc.
				
Polish Fishing Club 
				
Polish  Scouts
				
Polish School
				
Polish Social Club
				
Polish  Veterans Association
				
Polonia Centre (Windsor) Inc.
				
Polonia Centre Cultural Committee
				
Polonia Park Association
				
Polonia Sports Club
				
Plomien Vocal & Theatrical Group
				
River Gardens Homes Association				
Tatry Song & Dance Ensemble

Veterans Women’s Auxilliary
				
Zywy Rozaniec
				
Other

				

5.  YOUR INVOLVEMENT WITH THE  “WINDSOR” COMMUNITY 
Do NOT include mandatory volunteer hours to meet the Secondary School graduation requirement.

            Organization	                     Dates	             Your Involvement	

			

How did you complete the 40 hours of Volunteer Service for Secondary School graduation? _________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

6.  ACADEMIC and PERSONAL ACCOMPLISHMENTS (Secondary School and Beyond only)
  Provide copies of documentation if available. 

    Year	                                           Award/Accomplishment	

		

7.  EMPLOYMENT HISTORY (last 4 years only)

      Dates of Employment	        Company	           Position	    Hours per week	

				

	

	
8.  ESSAY.   Please respond to the following question in either the Polish OR English language.  The essay should contain a maximum of 250 words, typed with double spacing, using a standard margin.

“By receiving the Polonia Centre Academic award, how will you be able to help the Polonia Centre organization carry on it’s mission of supporting and participating in the cultural, educational and charitable events of the Polish community in Windsor, Canada, and the world?”

9.  DECLARATION

I certify that the information in this application is true and accurate to the best of my knowledge. 
I understand that an incomplete application will not be considered and will be returned to me.

Applicants’ signature:___________________________________ Date ____________

             10.  RELEASE

I permit the use of my photograph in any promotional material and the posting of my Essay on the website www.poloniawindsor.ca as deemed appropriate by Polonia Centre Windsor (Inc).

Applicants’ signature:  _________________________________  Date _____________