LT SCHOLARSHIP PERSONAL INFORMATION

Surname Serapio Given Names Ethan, Mauro

Street Address 12345 67a Ave
City: Surrey Province British Columbia
Postal Code V3S 4P8 Phone 111 222 3333
Email address notarealemail@email.com
Date of Birth 28/03/2001 (Day/Month/Year) SIN : 111-222-333

Next of Kin: Chona Serapio Relationship: Mother

Street Address: 12345 67a Ave
City: Surrey Province: British Columbia
Postal Code: V3S 4P8 Phone: 222 333 4444

Do you have sibling? List their gender and age

Gideon Serapio, Male, 24 years-old

Are One or Both Parents employed? (Circle)

Father’s Employer Steel Tech Detailers Mother’s Employer Steel Tech Detailers
Address 5678 45a Ave Address 5678 45a Ave
Yearly Salary $121,000 Yearly Salary $120,000

Is your family able to contribute to your education costs or living expense? YES or NO
If NO, briefly explain

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 LT SCHOLARSHIP PERSONAL INFORMATION

Will you Graduate High School in June?

Name Lord Tweedsmuir Secondary
Location Cloverdale
Street Address: 6151 180 St
City: Surrey Province: British Columbia
Postal Code: V3S 4L5 Phone: 604-574-7407

Are you Employed? YES or NO

If YES, how long Company Name
Supervisors Name Phone number
Street Address:
City: Province:
Postal Code:

Did you Volunteer? YES or NO

If YES, list Year, Organization and Supervisor.(Insert additional page(s) if required)
Year Organization Supervisor
2012/13 Surrey Food Bank Ms. Macdonald

Did you play Sports in the Community? YES or NO

If YES, list Year, Organization and Supervisor.(Insert additional page(s) if required)
Year Team Coach

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Did you play Sports on a School Team? YES or NO

If YES, List year, Team and Supervisor. (Insert additional page(s) if required)
Year Team Coach

Did you belong to any Clubs or Organizations? YES or NO

If YES, list Year, Organization and Supervisor. (Insert additional page(s) if required)
Year Club/Organization Supervisor
2013- present Head x Heart Youth Daniel Borbe

Did you belong to any Fine Art Clubs (Music, Art or Dance) or Organizations ? YES or NO
If YES, list Year, Organization and Supervisor. (Insert additional page(s) if required)
Year Type/Club/Organization Teacher
2014- present Lord Tweedsmuir Band Mr. Rutley Mr. Delepeña

What Awards/Certificates have you Won? (Insert additional page(s) if required)

Year Award/Certificates
2015 Surper G / Honour Roll / Outstanding instrumentalist

2016 Super G / Honour Roll

2017 Super G / Honour Roll

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List your Hobbies and General Interests? (Insert additional page(s) if required)

- Helping others
- Technology
- Video Editing
- Cooking

What Post Secondary Program are you enrolling in:

Program Health Sciences and Nursing
Institution Kwantlen Polytechnic University
Location Surrey

Is your program leading towards a: Certificate Diploma Degree

How long is your program? (1 year equals 8 months of full time studies) 4 years
When will you start your program? September 2019

As briefly as possible indicate to the committee your goals and aspirations upon completion of
your studies.(Insert additional page(s) if required)
My goals after completing my education is to help those in need and use my skills in a positive way. I want to be the

person that people go to when they need help both physically and mentally. I want to work at Surrey Memorial

Hospital caring and working with patients.

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Expenses: What do you estimate your following expenses will be?

a) Tuition $11,582
b) Text Books $1,500
c) Other Academic Supplies $1,000
d) Accommodation $6,000
e) Food $2,000
f) Transportation U-Pass
g) Other (Identify)