Scholarship Application

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The Andrew Goussaert Memorial Scholarship

Online Application Portal

Since you cannot save your application form and return, its best to prepare your materials before you begin.

Application Checklist

Application Form
Confirmation of graduation (high school transcript, copy of diploma, or other documentation)
Assignment Submission
Confirmation of enrollment into your
post-secondary program (optional)
Letter of reference (optional)

Looking for
more info?

Visit our
How to Prepare Your Application
page before proceeding.

Step One: Applicant Contact Info

First Name

Last Name

Date of Birth

Phone Number

Street Address/PO Box:

Community/City

Province/Territory

Postal Code

Step Two: Tell us about yourself!

Where are you from, what are your planned areas of study, and what do you hope to achieve with your education?

Short Biography (Max 300 Words)

Arctic Co-ops is committed to diversity and inclusion and strives to ensure that awarded applicants are representative of the communities we serve. Arctic Co-ops encourages interested applicants to self identify if they are a member of any minority groups, including but not limited to: Indigenous peoples, persons with disabilities, visible minorities, and members of the LGBTQ2S community.

Step Three: Co-op Affliation

Are you a member of your local Co-op?

Are you a current employee or volunteer at your local co-op?

Is your parent or guardian an employee or member of your local Co-op?

If your previous answer was yes, please state the name of your parent or guardian.

Step Four: Demographic Survey

Other

Step Five: Education

Name of Highschool or Equitable Program

Year of Graduation

Check all that apply to you

This is my first time applying to a Post-Secondary Program I am currently midway through my Post-Secondary Program I have attended Post-Secondary before but did not complete the Program

Have you completed a Post-Secondary Program before?

If yes, please name the Program.

Step Six: Aspirations

What is your planned area of study?

Tell us about your dream career (Max 100 Words)

Step Seven: Post-Secondary Info

Name of Program:

Length of Program

Mailing Address of Post-Secondary Institution

Street Address/PO Box

Community/City

Province/Territory

Postal Code

Resulting Certification (ex. Degree, Certificate, Diploma, etc.)

Projected Start Date

Projected Graduation Date

Current Status of Enrollment

Step Eight: Funding

Is your Post-Secondary Program supporting you with any funding?

If yes, state the amount:

Are you receiving any other funding (Scholarships, Bursaries, Government Support, etc. for your studies?)

If yes, describe below:

Funding Source #1

Amount

Funding Source #2

Amount

Funding Source #3

Amount

Step Nine: Consent and Declaration

I, the undersigned, hereby consent to the perpetual use by Arctic Co-ops and any affiliates of my photograph, likeness and/or any part of my submission including art, recordings and including, but not limited to, any of those identified above in the assignment section (the Submission) for the promotion or furthering the mission of Arctic Co-ops Post-Secondary Scholarship or for any other purpose in Arctic Coop’s discretion. I understand that I will not receive separate compensation or consideration from Arctic Co-ops or anyone else for the permission granted in this Consent nor for the actual publication or use of my Submission. By signing this Consent, I understand I am releasing Arctic Co-ops from any and all liability that may occur as a direct or indirect result of Arctic Co-op’s use of my Submission, the release of my identity, or any public relations materials.

I declare that the information provided in this application is true and correct. I understand that any wilful dishonesty by me may result in my application being denied or if such dishonesty is identified after any award of funds, such funds will be immediately due and owing to Arctic Co-ops. I confirm that I am a Canadian citizen and eligible to enroll in post-secondary education

Step Ten: Attach Your Files

Click here to attach mutliple files, up to a size of 4 MB.

If your attachments are better shared via a url (ex. dropbox, Google drive, Youtube, Soundcloud) please paste the link below.

Thats it! Click the "send" button to submit your application!

All personal information gathered through the application process will be kept private and confidential by Arctic Co-ops, and will not be shared with third parties. The information gathered will only be used for determining the award recipients of the scholarship.

The Andrew Goussaert Memorial Scholarship

Online Application Portal

Since you cannot save your application form and return, its best to prepare your materials before you begin.

Application Checklist

Looking for more info?

Visit our How to Prepare Your Application page before proceeding.

All personal information gathered through the application process will be kept private and confidential by Arctic Co-ops, and will not be shared with third parties. The information gathered will only be used for determining the award recipients of the scholarship.

If you require assistance with your application, please contact scholarships@arctic.coop.

Looking for
more info?

Visit our
How to Prepare Your Application
page before proceeding.