Rosedale United Church

The Rosedale United Church

Millennium Youth Award  -  2011

Application Form

Deadline: May 28, 2011

Winner will be announced on or before June 25, 2011

Applicants may be requested to meet with 2-3 committee members

for a personal interview.

(Please click and drag the material below into a WORD document to return to us.)

Applicant Name:_________________________________________________

Date of Birth:____________________________________________________

Age as of May 28, 2011____________________________________________

(Applicants must be between 17-25 years of age as of this date.)

Address________________________________________________________

Phone: (H)_______________________  (B)____________________________

E-mail__________________________________________________________

Sponsoring Organization: (From “Eligible List:)__________________________

Address_________________________________________________________

Phone: _______________________    (FAX)  ___________________________

E-mail__________________________________________________________

Name of Sponsor__________________________________________________

Phone: (H)_______________________  (B)____________________________

E-mail__________________________________________________________

All applicants please answer the following questions:

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Rosedale United Church

Millennium Youth Award Application Form

1)    Please tell us why you are applying for the Millennium Youth Award (include what you intend to do with the award money).

2)    How would the Award really make a difference in whether you achieve your dreams or goals?

3)    Where do you or did you attend school?

4)    What are or were your favourite subjects?

5)    What subjects do you or did you find difficult?

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6)    Besides school classes, what other activities do you like to be involved in at school or outside of school?

7)    In what ways do you feel you are helping or have helped people in your community, whether it is in your neighborhood, school, church, family, or elsewhere?

8)    Is there anything else you would like to mention about yourself, about your goal or dream, or about this application?

Other than your sponsor, please provide the name of one other person who could provide a reference for you e.g. a teacher, minister, or coach etc.

Name of reference: __________________________________________________________

Address____________________________________________________________________

Phone: (H)_______________________    (B)  _____________________________________

E-mail_____________________________________________________________________

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Sponsor Section

All Sponsors please answer the following questions:

1)    How long have you known the applicant?

2)    In what capacity do you know the applicant?

3)    Why do you feel the applicant is deserving of the Millennium Youth Award?

______________________________                   ____________________________________

Applicant’s Signature                                             Sponsor’s Signature

How to Apply

Send your completed signed application to:

The Millennium Youth Award

C/o Rosedale United Church

159 Roxborough Drive

Toronto, Ontario

M4W 1X7