Difference-Maker Scholarship Nomination Form

Difference-Maker Scholarship Nomination Form

Student:

First Name:

Last Name:

Student currently enrolled in grade:

Nominating Counsellor:

First Name

Last Name

Phone

Ex:

Email

Name of high school:

Address 1:

Address 2:

City:

Prov/State:

Country:

Postal/Zip Code:

Please share with us why you are nominating this student for the Trevor H. Shirtliff Difference Maker Scholarship:

Additional Information that would support your nomination in winning this award. (extracurricular activities, volunteer initiatives, etc.)

*Canadian School Counsellor magazine will publish any and all details of the nomination (student name, counsellor name,
school and reason for nomination) on the website and within the subsequent issue of the magazine.

Any additional supporting documentation can be emailed to donna@mzpinc.ca

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