Application Form

2010 JEAN LUMB AWARDS

PERSONAL INFORMATION: (Please print or type)

Name:

M/F:

Address:

City:

Postal
Code:

Phone:

Email:

High School:

Grade:

Chinese Name:

SUMMARY OF YOUR ACHIEVEMENTS:

Describe how you have achieved excellence on a separate page in 500 words or less, double-spaced and typed. You may attach a copy of your resume, as well as copies of any supporting documentation, like photos and newspaper articles (materials will not be returned). Do not include copies of awards and plaques. These can be listed in your resume.

REFERENCES:

Two references are required to support your nomination. At least one must be a staff member of your school. Have each of the two referees complete a Supporting Nomination Form.

The Jean Lumb Awards have four awards categories, each valued at $1000. Indicate your category(s). A separate application is required for each category.

ACADEMICS __ ATHLETICS __ ARTS __ COMMUNITY SERVICES __

• All nominations must be received by Monday, June 8, 2009

• Nominations and all supporting documentation become the property of the Jean Lumb Awards

• By participating, you agree to the use of your name and photographs for advertising and promotional purposes in connection with the Jean Lumb Awards without compensation.

Please forward your completed nomination to:


The Jean Lumb Foundation
201 – 411 Dundas Street West
Toronto, ON M5T 1G6

CHECKLIST: (Please check-off as appropriate when completed)
** Please provide 2 copies of all items below **

___ Application form

___ Summary of my achievements

___ Supporting Nomination Form from my school

___ Additional Supporting Nomination Form

___ Copy of my resume

I certify that I am of Chinese descent and that I am a Canadian citizen or landed immigrant.


______________________________________                            _____________________
Signature                                                                                        Date

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