Lowell Phillips Scholastic Award
Application Form



ELIGIBILITY:


NAME:_______________________________________________________________________

ADDRESS:____________________________________________________________________

POSTAL CODE:_____________TELEPHONE:______________________________________

SCHOOL:_______________________GRADE:_______________________________________


NAMES AND ADDRESSES OF TWO REFERENCES

1.
Name:__________________________________________________________________

Address:________________________________________________________________

Postal Code:___________________Telephone:_________________________________


2.
Name:__________________________________________________________________

Address:________________________________________________________________

Postal Code:_____________Telephone:_______________________________________


PROGRAM OF STUDY PLANNED FOR COMING YEAR:

School, College or University:_______________________________________________

Program:________________________________________________________________

PLEASE ATTACH:


MAIL TO:


Lowell Phillips Scholastic Award
c/o Community Foundation of Prince Edward Island
119-121 Queen Street, Suite 105
Charlottetown, PEI C1A 4B3






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