2015-2016 Kitchener Rangers/Ivan Tennant Memorial Scholarship Award
The Kitchener Rangers/Ivan Tennant Memorial Scholarship Award is an award available to students from
the Region of Waterloo entering first-year undergraduate studies in a Canadian post-secondary
institution.
STUDENT DETAILS
Name of Student: _______________________________________________________________________
Mailing Address: _______________________________________________________________________
_________________________________________________________ Postal Code: _________________
Phone: ________________________________ Email: _______________________________________
Secondary School Attended: ______________________________________________________________
Post-Secondary Institution: _______________________________________________________________
Program: _________________________________________ Student Number: ____________________
Do you have any present or prior association with the Kitchener Rangers Hockey Club?
Yes: ________ No: ________ (If yes, please specify)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
APPLICANT ELIGIBILITY
To be eligible, students must (please check):
 Be a graduate of a secondary school in the Waterloo Region.
 Be registered in a first-year undergraduate program in a recognized Canadian post-secondary
institution.
 Have a solid academic performance.
 Demonstrate leadership and involvement within the community.
SELECTION
The Scholarship Committee will evaluate the nominations and applications together with all supporting
documents and make the final selections.
APPLICANT INSTRUCTIONS
A completed application must include three (3) copies of (please check):
 A fully completed application form.
 A copy of the applicant’s high school transcript.
 A statement outlining how the applicant meets the criteria, exemplifies leadership and community
involvement, as well as details on their career/life ambitions and why they have chosen their
particular post-secondary program. The statement should also demonstrate initiatives the applicant
has personally undertaken to finance their post-secondary education. The statement must be
composed by the student and must not exceed 1,000 words.
 Signed Declaration and Consent.
AWARD PRESENTATION
Applicants will be notified by September 30th. Awards will be paid in the second semester and directly to
the recipient’s Post-Secondary Institution. Successful recipients will be invited to attend a Kitchener
Rangers hockey game and participate in a pre-game on-ice ceremony in recognition of their award.
DECLARATION AND CONSENT
To the best of my knowledge, all information submitted with this application is accurate, and I confirm
that my intention is to further my education with registration at a recognized post-secondary institution
in the immediate autumn term.
I agree that the Kitchener Rangers Hockey Club may use my personal information in the form of my
Photographs and my name/school, likeness or biographical information supplied under the authority of
Ontario’s Freedom of Information and Protection of Privacy Act.
Print Name: _________________________________________ Date: ________________________
Applicant’s Signature: ________________________________________________
Kitchener Rangers Hockey Club – Scholarship Committee
400 East Avenue
Kitchener, Ontario N2H 1Z6
(519) 576-3700
DEADLINE TO APPLY: FRIDAY, JULY 10, 2015