Scholarship Application
This is for individuals to complete to apply for the QAS service at a reduced rate. It is our way of giving back for those that want change. Once the completed application
* Required
First Name
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Your answer
Last Name
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Your answer
My email address is :
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Your answer
A brief description how I got to this service or what drew me here?
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Your answer
Why are you requesting a Scholarship?
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Your answer
What services do you wish to apply for and who? (ie; Empower service? Location? Situation? and is it just for you or others in your family?)
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Your answer
I have read and agree to the Scholarship Terms and Conditions on the website (
https://www.mycw.ca/scholarship-terms/
)
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I agree to the Terms
I commit to providing feedback in the form of a monthly short survey in exchange for this service.
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I commit to complete monthly surveys.
I understand and agree that if I do not provide feedback as agreed to in the terms and conditions, my service will be cancelled and this service will not be offered as a scholarship for the rest of this life.
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Yes, I understand
Required
I commit that once I begin this service I will remain on the service for at least 3 months to see how it effects my life .
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I agree to 3 Months
I agree to my feedback being used in any form the Company chooses. We will never disclose personal information except as agreed to below.
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I agree the Company can utilize my feedback on a first name basis.
I agree the Company can utilize my feedback but ONLY anonymously.
I can commit the following amount per month in exchange for this service (please provide the amount below). $CDN
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Your answer
I agree that I will review the amount I provide for this service every 6 months.
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I agree to re-evaluate the amount I can contribute every 6 months.
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