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MARGARET WILLIAMS TRUST FUND Award Application (To be returned by April 13, 2012) GENERAL INFORMATION: NAME (Dr., Mr., Ms., Miss, Mrs.): ADDRESS: (Street No.) (City) (Province) (Postal Code) TELEPHONE
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Are you a Canadian citizen or a permanent resident? (What year did you become Canadian?) Which federal government fund(s) is your claim for funding for your application? (For example, your case is under the Children's Fitness to Enrollment Award program, but you will also need funding from: the Department of Finance, the Canadian International Development Agency, Health Canada, the Canadian Institutes of Health Research or similar federal government fund, the Economic Development Agency of Canada, the Citizenship and Immigration Canada Act or similar federal government program, the Canadian Forces, the Canada Revenue Agency, the Canada School of Public Service, the Canadian Security Intelligence Service, the Government of Canada, the Department of National Defense, or similar government program, and/or the government of Manitoba.) 3(b) — Federal funding received during fiscal year Has your federal funding received during the last 12 months? (Do you expect to receive federal funding in the next 12-18 months?) No Yes If not in your first 12 months, have you thought about applying for more federal funding during the next 12 months? (Think about how you would use the money.) No Yes Do you believe that your federal funding qualifies to qualify for the special funding eligibility? (Yes or No?) Yes No (For all years: if yes, what year do you expect to need the special funding? ) (For all years: if yes, what year do you not need the special funding? ) (In the future, do you believe that your current funding qualifies to qualify for any of the following: the Healthy Child and Youth program, the PEN Canada fellowship, the Canadian Student Loan program, the International Student Award program, the Senior Apprenticeship Award, the Professional Recognition Awards program, or the University Scholarships Program?) Yes (If yes: what will you do (if you are applying directly to a school, etc.)) No Not applicable. To complete this checklist, you will need: — Your full name; — the total amount of federal funding you received in your last 12 months (not including any funding you received in previous years); — The school(s) or organization(s) you are applying to; — the type of scholarship or fellowship you are applying to; — the amount of any other funding you received recently; and — your reasons for applying to the school. If this question is not applicable to your project, please leave this space blank.

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