Burlington Blaze Scholarship Application 
Name:_______________________________________________________
Home Address: ________________________________________________
Phone Number: _____________________ email:_____________________
Education:
Secondary School:______________________________________
Current %__________________________ *please provide transcript or counsellor’s signature
Schools Applied to for the Fall: Programme:
1. _______________________________ ________________________
2. _______________________________ _________________________
3. _______________________________ _________________________
4. _______________________________ _________________________
Have you been accepted? If yes, which school will you be attending?
___________________________________________________________________
Volleyball Experience as a Blaze Player:
Year: ______________________ Coach:______________________
Year: ______________________ Coach: _____________________
Year: ______________________ Coach:______________________
Year: ______________________ Coach: _____________________
Year: ______________________ Coach: _____________________
Other Volleyball Experience: (please include school, other volleyball organizations, volleyball selection programmes, leadership roles, awards won, highlight events, etc.)
Write a brief (200 – 300 word) description of the contribution that you have made to the Burlington Blaze Volleyball Club, both on and off the court, during your years as a player. Include in your presentation, any information that would contribute to your candidacy for this scholarship.
Irene Prime, 1311 Roseto Court, Burlington, Ontario. L7P 4L4
Due Date: May 10th of the current year.