Presidential Scholarship Church Leader Reference Form

Value: Full tuition for up to four consecutive years

Deadline: January 31

TO THE APPLICANT:

Please send this link: https://ambrose.edu/form/presidential-scholarship-church- to your designated reference and have them complete and submit it online.

TO THE REFERENCE:

This applicant has applied for Ambrose University's Presidential Scholarship. The following information will be used in determining the applicants eligibility. Please answer the questions and complete the form fully. Upon completion, please hit submit at the bottom of the page.

Applicant's Name:

First

Last

Phone number

Community Leadership (please check)

Music

Church Ministries

Missions Involvement

Community Service

All of the above

Please explain involvement

Christian Character

I certify that the information provided in this reference form is true and complete in all aspects. I understand that Ambrose University will use the above information in selection for the Presidential Scholarship and will be in contact with the student directly.

Pastor Information

First

Last

Pastor or Church Leader Email

Church Name

Church Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Date

The personal information collected on or in conjunction with this form is collected under the authority of the Personal Information Protection Act (PIPA), the Statistics Act (Canada) and the Income Tax Act (Canada). It is required to determine your eligibility for admission and will be used to contact you regarding programs and services. It will form part of your record as an applicant, student, and alumnus and may be disclosed to academic and administrative units. Specific data elements may be disclosed to the Federal and Provincial Governments to meet reporting requirements. Since the Jason Lang Scholarship is a Student Aid Alberta Scholarship, this information will be given to Student Aid Alberta. If you have any questions about the collection, use or disclosure of this information, call the Student Aid Alberta Service Centre toll free at 1-855-606-2096 from anywhere in North America. You can also mail your questions to Student Aid Alberta, PO Box 28000 Station Main, Edmonton, AB T5J 4R4. All other information is considered confidential and will be used and disclosed in accordance with privacy legislation. For more information regarding the collection or use of this information, please contact the Privacy Compliance Officer (403-410-2000 or e-mail privacy@ambrose.edu).

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Presidential Scholarship Church Leader Reference Form

Value: Full tuition for up to four consecutive years

Deadline: January 31

TO THE APPLICANT:

TO THE REFERENCE:

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