Thalassemia Foundation of Canada Scholarship Form



The Thalassemia Foundation of Canada is proud to announce the Thalassemia Secondary Student Excellence Award. The award shall be given to a Canadian Secondary School student with Thalassemia Major or Intermedia. The purpose of this award is to recognize Thalassemia patients who demonstrate determination, commitment, and enthusiasm. These qualities can be revealed through the candidates’ academic achievements, extracurricular activities, and volunteer work. The Thalassemia Secondary Student Excellence Award is intended to motivate and encourage Thalassemia patients to continue to work through life’s challenges, contribute to their community, and share their talents/gifts with others.Award Content: Two (2) awards available, valued at $500 each payable to the winner. Submission Deadline: February 15, 2021. Submit Parts 1 & 2 (see below).Submit to: tony.falcitelli@thalassemia.ca. Please request a confirmation of receipt.Questions: tony.falcitelli@thalassemia.caRequirementsMust be a person with Thalassemia Major or Intermedia.Must be a Canadian resident attending Secondary School (Grades 9-12).With permission, recipient’s name, photo, video may be posted on the Thalassemia website and published in the Thalassemia newsletter.Part 1: Submit a 1 page essay, including:Brief description of the applicant: e.g. family, activities, hobbies; volunteer work (if applicable).Impact of Thalassemia on your life and things you do to keep a positive attitude when dealing with the challenges of having Thalassemia.Describe how this scholarship will benefit you.Part 2: Completed Application Form, see p.2Part 2: Application Form.1) Applicant InformationLast nameGiven nameDate of birth (MM/DD/YY):AddressCityProvincePostal CodeHome TelephoneAlternate TelephoneE-mail Address2) School InformationName AddressCityProvincePostal CodeTelephoneGradeTeacher’s Name3) Describe any extracurricular activities that you participate in (attach separate sheet if required):4) List future educational and career goals (attach separate sheet if required) in 250 words or less:Applicant’s Signature (if older than 16 yrs)Parent’s Signature (One parent) if applicant is less than 16 yrs old.Date ................
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