C.D. Fraser Memorial Scholarship

Applicant’s Name


Address


Telephone


Email


Parent(s)/Guardian Name


Insurance Firm (Parent/Guardian) associated with


Applicant’s Date of Birth


University Attended Last Academic Year (if applicable)


University to be attended next Academic Year


Intended Field of Study


Offices Held in Volunteer Organizations/Clubs/Groups


Extra Curricular Activities at School or in Community


Employment History (full, summer, part-time)


Career Objective


Scholarship or Academic Awards Received


I declare that to the best of my knowledge the information supplied on this application form is true and correct.

The closing date for receipt of completed applications is June 30.