HOCKEY ALBERTA REFEREE COUNCIL SCHOLARSHIP

HOCKEY ALBERTA REFEREE COUNCIL SCHOLARSHIP

Annually – Maximum of two (2) awards of $1,000.

Scholarships will be presented to officials in the province that have applied for and met the following criteria:

o A member in good standing with the province in the current season and holds a minimum of Level 2.

o A resident of Alberta for at least 2 years.
o 18 years of age by December 15th of the season they are applying for

scholarship.
o Anactiveofficial,workinggamesatanylevel.
o Attendingapostsecondaryinstitutioninarecognizedprogramonafulltime

basis. This will also include a recognized trade school program. Transcript of

class enrolment is required.
o Other criteria will include, but is not limited to, the applicant’s on-ice ability

and off-ice contribution to his/her zone.

Application deadline is April 1st of each year.
Applicant could be applying for the year just being completed in order to qualify.

Completed applications, including transcripts and personal statements, are to be sent to the Provincial Past Chairman who will lead a committee to select the successful candidate(s).

The Selection Committee will consist of:

o Provincial Past Chairman o 1 Zone Chairman
o 1 Member at Large

DEADLINE:

INFORMATION:

HOCKEY ALBERTA REFEREE COUNCIL SCHOLARSHIP

A.

NAME: ADDRESS:

CITY:

PHONE/FAX: E-mail:

Date of Birth:

(Last)

(Home)

(MM)

PROV:

(Business)

/

(First)

P/C:

(Fax)

/

(DD)

(YYYY)

B.

Please attach a transcript of your most recently completed year of academic study.

1. HighSchool: Location:

2. SecondaryAcademicRecord

   Grade 11 Average Final Grade:

   Grade 12 Average Final Grade:

3. Current Post Secondary Institute

   Institution Name and Location: Program of Study:
   Student #:

4. OR, Intended Post Secondary Institute Institution Name and Location: Program of Study:
   Planned Start Date:

HOCKEY ALBERTA REFEREE COUNCIL SCHOLARSHIP

C.

5. Current level of Hockey Canada Officiating Program Certification:

6. HockeyAccomplishments

7. Personal Statement

8. PleaseattachaletterofreferencefromyourLocalZoneChairmanandprovidehis/hercontact information below:

Name: Phone: Email:

HOCKEY ALBERTA REFEREE COUNCIL SCHOLARSHIP

D.

Please note these conditions before signing this application:

The information provided in this application is true, accurate and complete.
I am aware that providing incomplete or false information will render my application null and void and will not permit me to compete for this scholarship.
I authorize the Hockey Alberta Referee Council to verify student information included to determine eligibility for this scholarship opportunity.
I am aware that the granting of this scholarship is subject to the conditions listed in the letter of notification.
I authorize the Selection Committee to contact my references as required.
I authorize the Hockey Alberta Referee Council to make copies of this application and distribute it to the Selection Committee for the purpose of review.

Signing this consent form permits the Hockey Alberta Referee Council to publicly recognize your achievement as a recipient of this scholarship.

If selected for this scholarship, consent is given to the Hockey Alberta Referee Council to publish the student’s name, school, location and scholarship received. It is understood that not signing this consent will not prejudice the consideration.

Applicant’s Consent (signature): Date:

E.

All applicants will receive notification that their application package has been received. Scholarship recipients will be notified by the Hockey Alberta Referee Council on or before April 1, 2012.

Please use the following checklist to ensure your application package is complete.

• □  Completed application form – dated and signed by applicant

• □  Copy of most recent transcript – High School or Post Secondary Institute

• □  Copy of personal statement regarding application

• □  Letter of support from Local Zone Chairman

  Completed application package must be received by the Past Chairman on or before April 1, 2012 at 4:00 pm (MT).

  Wally Popik
  RE: Referee Council Scholarship 60 Grandin Woods Estate
  St. Albert, AB T8N 2Y4

  wpopik@telus.net

Applicant’s Signature:

Date: