SASKATCHEWAN TRUCKING ASSOCIATION,
HIGHWAY AGENCIES LTD., and STA ASSOCIATE TRADES
Tuition Scholarship Application Form
Name: _______________________________________________________________
(First)
(Middle)
(Last)
Current Address:
______________________________________________________
(Number and Street)
______________________________________________________
(City)
(Province and Postal Code)
Mailing Address:
______________________________________________________
If different from above (Number and Street)
______________________________________________________
(City)
(Province and Postal Code)
Current Phone: (___)_______________
Permanent Phone: (____)_______________
Social Insurance: _________________________________________
I will be Enrolled Full Time at: ____________________________________________

In the Degree
________________________________________________

Diploma
________________________________________________

Certificate
________________________________________________
1. Date of Birth:
______________________________________________________
Place of Birth:
______________________________________________________
(City and Province)
2. Name and Occupation of Parents/Guardians:
a) Father:
____________________________________________________________
(Name)
(Occupation)
___________________________________________________________
(Employer’s Name, Address, & Phone number)
Page 1 of 6
Application Form (continued)
b) Mother:
____________________________________________________________
(Name)
(Occupation)
___________________________________________________________
(Employer’s Name, Address, & Phone number)
3. Indicate below your preparatory education:
High School:
______________________________________________________
(Name)
____________________________________________________________
(Dates)
____________________________________________________________
(City, Province & Postal Code)
Other:
_________________________________________________________
4. Give a complete academic resume for your grade twelve year and any additional
years (if applicable) in college etc.
PLEASE PROVIDE ALL TRANSCRIPTS
GRADE TWELVE: (COMPLETE SECTIONS 6 & 7)
NAME/LOCATION OF
INSTITUTION
DATES OF ATTENDANCE
LIST ALL COURSES AND
GRADES RECEIVED
DATES OF ATTENDANCE
LIST ALL COURSES AND
GRADES RECEIVED
FIRST SEMESTER:
NAME/LOCATION OF
INSTITUTION
Page 2 of 6
Application Form (continued)
SECOND SEMESTER:
NAME/LOCATION OF
INSTITUTION
DATES OF
ATTENDANC E
LIST ALL COURSES AND
GRADES RECEIVED
DATES OF ATTENDANCE
LIST ALL COURSES AND
GRADES RECEIVED
THIRD SEMESTER:
NAME/LOCATION OF
INSTITUTION
5. List academic honors you received in college, including scholarships, fellowships and
prizes and honorary scholastic societies to which you have been elected. Please
identify titles that are not self-explanatory and provide dollar value of scholarships.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. List and identify the extracurricular activities in which you have participated and the
High School, college clubs and organizations of which you have been a member,
indicating any offices held.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
7. List your activities and memberships in organizations other than school related.
____________________________________________________________________
____________________________________________________________________
Page 3 of 6
Application Form (continued)
8. Describe briefly any independent study, research, or writing you have completed or
are now completing, including (1) where and (2) under whom completed. (Do not
send copies)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
FOR ALL APPLICANTS:
9. Please indicate your major field of study and your plans after graduation.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. List in reverse order, beginning with the latest, the last three full-time or part-time
jobs, in which you have been employed for more than six months.
EMPLOYER
ADDRESS
DATE
TYPE OF WORK
EMPLOYER
ADDRESS
DATE
TYPE OF WORK
EMPLOYER
ADDRESS
DATE
TYPE OF WORK
Page 4 of 6
Application Form (continued)
FOR THOSE ALREADY ATTENDING A POST-SECONDARY INSTITUTION:
11. Estimate the extent to which you have been self-supporting thus far during your postsecondary education. _______%.
About how many hours weekly (average) did you work during the last school year?
_______________________________________________________________________
During the current school year? ______________________________________________
Describe the nature of your work during your post-secondary years:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
FOR ALL APPLICATIONS:
12. Give as references the names of four persons, not relatives who know your abilities.
For those attending a post-secondary facility, a facility advisor or professor and at least
one other person with whom you have studied should be included.
NAME
OCCUPATION
ADDRESS
PHONE
1.
2.
3.
4.
13. On a separate sheet of paper, type a 500 word statement explaining why you should
receive a scholarship and any other factors that should be considered with reference for
this application.
Signature: ___________________________________ Date: __________________
Page 5 of 6
Application Form (continued)
In answering any question should more space be required, please feel free to completely
answer the questions on a separate sheet and attach it.
Please return to:
Saskatchewan Trucking Association
Scholarship Selection Committee
1335 Wallace Street
Regina, Saskatchewan S4N 3Z5
Telephone: (306) 569-9696 or 1-800-563-7623
Fax: (306) 569-1008
APPLICATIONS MUST BE SUBMITTED
BY JUNE 30, 2015
Official transcripts should be mailed by the Department of Education
as soon as possible.
Transcripts from the Registrars Office should be mailed direct from
the Registrars Office as soon as possible.
Page 6 of 6