Help us get to know you:
Do you identify as First Nations, Métis, and/or Inuit/Inuk?
*
Please Select ---
No
Yes
Prefer not to answer
What do you consider to be your racial identity?
*
Prefer not to answer
What is your ethnic or cultural background?
*
Prefer not to answer
What language(s) do you feel most comfortable speaking?
*
Prefer not to answer
What is your gender identity?
*
Prefer not to answer
What is your sexual orientation?
*
Prefer not to answer
General Information:
Title:
*
Please Select ---
Miss
Ms
Mr
First Name:
*
Last Name:
*
Street Address:
*
City:
*
Province
*
Please Select ---
ON
AB
BC
MB
NB
NL
NT
NS
NU
PE
QC
SK
YT
Postal Code:
*
Telephone Number:
*
Email Address:
*
Name of current Secondary School, College or University:
*
Currently In:
*
Please Select ---
Grade 12 - Hope to be accepted at University
Grade 12 - Hope to be accepted at College
University / College Year 1
University / College - Year 2
University / College - Year 3
What area of study are you interested in?
*
Family Information
Name of parent with Hamilton Health Sciences relationship
*
Position:
*
Department:
*
Site:
*
Employee # (if applicable)
Employee or Associate Since:
*
Attach File:
An essay, up to 500 words in length, on your educational journey to date, and what lead you to your studies.
An essay, up to 500 words in length, on what is inclusive leadership to you, and how do you demonstrate leadership in academic, social, and community settings?
Please include a copy of your Academic Transcript.
PLEASE NOTE: ESSAYS AND TRANSCRIPT MUST ALL BE CONTAINED IN ONE PDF FILE.
Declaration:
I declare that all statements made in this application are true and complete and may be subject to verification should I be selected as an award recipient.
Please accept the Declaration
or [
Return to Front Page
]