BC Leslee Jean Arnet Adult Bursary Application Form Name* First Last iMIS Number* Address* Street Address Address Line 2 City Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell Phone*Email* Enter Email Confirm Email Guiding Area*Fraser SkiesKootenayLionsLougheedMonasheePacific ShoresRivers NorthSouthern Vancouver Island (SVI)Thompson NicolaWest CoastBirth Date* MM slash DD slash YYYY Are you a single mother with one or more dependent children?* Yes No How or where did you find information about Girl Guides of Canada Bursaries, Grants and Scholarships in BC?* Canadian Guider Fellow Guider Pipeline Social Media Workshop from BC Awards Committee List, in point form, positions(s) held (including dates) as an adult Guiding Member during the last three years. If you are 19-21 years of age, please list, in point form, your leadership positions and achievements (including dates) as a girl member.*Indicate how you will continue your involvement in Guiding.*List, in point form, community/volunteer services and dates during the last three years.*List, in point form, employment positions held during the last three years including dates, duration and average hours per week. If you have not been employed or had gaps in your employment, please state why.*Educational facility/training center you are planning to attend:* Course of study:* Duration of the course:* What are your career plans?*Full-time or Part-time student:* Full-time Part-time List anticipate expenses related to your course of study (i.e. childcare, books, supplies and transportation). Be as detailed as possible, including costs if known.*(5 points)Cost of tuition:* Are you presently employed?* Yes No If you are employed, is it Full-time or Part-time?* Full-time Part-time Present monthly income:* Less than $500 $500 - $1000 $1000 - $2000 $2000 - $4000 $4000 or Greater How many dependent children do you have?* Are you the sole income earner?* Yes No Explain your financial need for this bursary.*How much will your income change while attending school?*Give us an example of something you have done in Guiding that has impacted someone else’s life in a positive manner?*(150 words maximum)Explain how Guiding has enriched your life and prepared you for, or influenced, your anticipated career plans.*(150 words maximum)I verify that everything I have stated above is correct, true and accurately represents my experiences* Yes No Initial Here:* Thanks!Thank you for completing the BC Leslee Jean Arnet Adult Bursary Application Form. 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