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Please complete the following form:
Fields marked with * are required.
* First Name:
* Last Name:
Title:
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Ven
Rev
Mr
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Ms
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* Address:
* City:
* Province/State:
(if applicable)
* Postal/ZIP Code:
(if applicable)
* Country:
* Home Phone:
Work Phone:
Email:
* Number of Scholarships to Sponsor:
1
2
3
4
5
The financial commitment needed for each scholarship is Can$11.25 per month for a period of two years (total of $270). This amount will be automatically deducted from your bank account each month (currently only Canadian accounts).
Comments/Notes:
