Application Form

2012 JEAN LUMB AWARDS

PERSONAL INFORMATION: (Please print or type)

Name:

M/F:

Address:

City:

Postal
Code:

Phone:

Email:

High School:

Grade:

For Grade 12 applicants only:
I have been accepted at:

To study:

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. Attach a copy of your resume, as well as 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 five awards categories, each valued at $1000. Indicate your category(s). A separate application is required for each category.

ACADEMICS __ATHLETICS __THE ARTS __
COMMUNITY SERVICES __INNOVATION __

• All nominations must be received by 5pm, Monday, May 28th, 2012.

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

• Student winners are expected to attend the awards dinner in October 2012 or to submit a DVD of their acceptance speech.

• 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

___ One Supporting Nomination Form from my school

___ One 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

Back to Top