Diageo Wine and Spirits Award Application Form

Note: Items marked with an asterisk (*) must be completed.

Personal Information

First Name

Middle Name (optional)

Last Name

Status for Study in Canada

Canadian Citizen

Permanent Resident/Landed Immigrant

Protected Person

Contact Information

Email Confirmation

Academic Information

George Brown Polytechnic Student ID Number (if you have one)

What course or program are you currently enrolled in or interested in enrolling for?

Which term are you currently enrolled in or interested in enrolling for?

Personal Written Statements

Please provide a brief biography which will be used to tell the donor about you? Include your program, year of study, any obstacles you’ve overcome, your future goals, and how receiving an award would impact you.

Please list any extracurricular, volunteer, leadership, or entrepreneurial-related experiences that you have been involved in within the last three years. Include on-campus and/or off-campus experiences, and indicate the specific activities, your role and the significance of your experience. Feel free to include any non-paid experiences and explain how they contribute to helping others in the community.

Please describe your passion for your field of study, and your future academic and/or professional goals.

Student Budget

Please indicate your budget below. This budget should reflect the average resources and costs associated with studying at George Brown College during the academic year from September to April. Please ensure that all sections are completed.

Financial Resources	Amount ($)
Personal Savings (prior to study period)	Personal Savings (prior to study period)
Parental or Spousal Contribution (includes all contributions to any of your expenses)	Parental or Spousal Contribution (includes all contributions to any of your expenses)
Scholarships and Bursaries (includes any Continuing Education bursary funds)	Scholarships and Bursaries (includes any Continuing Education bursary funds)
Loans (i.e. bank line of credit, other family members)	Loans (e.g. bank line of credit, other family members)
Government Assistance (e.g. Social Services, EI, ODSP, OW, OSAP, DIAND)	Government Assistance (e.g. Social Services, EI, ODSP, OW, OSAP, DIAND)
Monthly Employment Income (calculate the income acquired in an average month within the academic year between September and April)	Monthly Employment Income (during the academic year)
Other Resources (specify)	Other Resources
Total Resources	total_resources_twig $ 0.00

Estimated Expenses	Amount ($)
Tuition and Academic Fees	Tuition and Academic Fees
Books and Related Supplies	Books and Related Supplies
Monthly Housing (e.g. rent, mortgage, home insurance, maintenance fees) (calculate the cost of an average month within the academic year between September and April)	Monthly Housing (e.g. rent, mortgage, home insurance, maintenance fees)
Monthly Utilities (e.g. water, electricity, gas, phone, cable, internet) (calculate the cost of an average month within the academic year between September and April)	Monthly Utilities (i.e. average month in the academic year between September and April; e.g. water, electricity, gas, phone, cable, internet)
Monthly Food (e.g. groceries, dining) (calculate the cost of an average month within the academic year between September and April)	Monthly Food (e.g. groceries, dining)
Monthly Transportation (e.g. public transit, automobile payments, automobile insurance, gas) (calculate the cost of an average month within the academic year between September and April)	Monthly Transportation (e.g. public transit, automobile payments, automobile insurance, gas)
Monthly Personal and Miscellaneous (e.g. clothing, personal care, medication, uncovered medical expenses, childcare) (calculate the cost of an average month within the academic year between September and April)	Monthly Personal and Miscellaneous (ie.g. clothing, personal care, medication, uncovered medical expenses, childcare)
Other Monthly Expenses (specify)	Other Expenses
Total Expenses	total_expenses_twig $ 0.00

Terms of Assessment

You will be contacted within two weeks (excluding college closures) after you submit this form to let you know if you have qualified to have your course/program fee(s) covered.

Declaration

By checking this box, I understand this information will be used to assess eligibility for any George Brown awards that I apply for and may be shared with the donor(s), authorized reviewing committee members, including faculty members and other George Brown employees when necessary and relevant to the selection.

By checking this box, I hereby declare that the information provided is true and correct.

Signature

Sign above.

General Collection Notice: George Brown Polytechnic (the “institution”) collects personal information under the authority of the Ontario Colleges of Applied Arts and Technology Act and in accordance with the Freedom of Information and Protection of Privacy Act. The institution collects personal information for the purposes of administering its statutory objects/powers, programs, and activities and to carry out other services and functions. The institution will secure personal information and use for such purposes as set out in the George Brown Polytechnic Notice of Collection. If you have any questions about the collection, use, and disclosure of personal information at the institution, please visit the institution-wide Privacy Policy page. You may also contact the Privacy Office via email at privacy@georgebrown.ca.

Fee Waiver Eligibility Form