Jim Colpitts Memorial Scholarship

THE ALPINE CLUB OF CANADA

JIM COLPITTS

MEMORIAL SCHOLARSHIP

This is the only form which can be used when applying for the Jim Colpitts Award. If your application is not fully completed it will be returned for completion to ensure our volunteer committee can properly assess all applications. Once you begin filling out this form your data will be saved at this url for ONE WEEK. Bookmark this page and return to it anytime within ONE WEEK to complete the form.

Please note the Selection Committee strongly prefers receiving applications in electronic format.

Full Name *

First Name Last Name

Date of Birth *

Month Day Year

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

ACC Membership Number *

Current Occupation

COURSE INFORMATION

Course Title *

Course Location(s) *

Course Start Date

Month Day Year

Course Duration

Total Course Expenses *

Amount applied for from ACC Colpitts Fund *

What is your objective for taking this course? *

Describe the course, including details of activities and itinerary. *

How do you plan to put your new skills to use if you are awarded this scholarship? *

Will undertaking this course assist you in meeting your career or outdoors goals? *

Is there any related information you would like the ACC to know? *

Attach a brief resume outlining relevant outdoors training, certifications and
experience (if any). Also include a very brief summary of education and
recent employment experience.

Resume *

BY CLICKING 'SUBMIT' I CONFIRM THAT, TO THE BEST OF MY KNOWLEDGE, ALL INFORMATION IN THIS APPLICATION IS ACCURATE. IF MY APPLICATION IS SUCCESSFUL, I AGREE TO ABIDE BY THE AWARD CONDITIONS STATED IN THE "AWARD RECIPIENT RESPONSIBILITIES" SECTION ON PAGE 4 OF THE APPLICATION INFORMATION PACKAGE.

THE ALPINE CLUB OF CANADA

MEMORIAL SCHOLARSHIP

APPLICATION FORM